Incidence and Mortality Associated with Primary Postpartum Haemorrhage Following In-Hospital Births in Northwest Ethiopia

Abstract

Background: Primary postpartum haemorrhage remains the primary cause of maternal mortality in low-resource countries such as Ethiopia. National datasets about the incidence of primary postpartum haemorrhage are often limited, incomplete or unavailable. This study was designed to determine the incidence, mortality, and factors associated with primary postpartum haemorrhage following in-hospital births.

Methods : This was a cross-sectional study design, an audit of 1060 maternity care logbooks of discharged women. The data were abstracted December to May 2018/2019 using systematic random sampling. The tool used was the Facility Based Maternal Death Abstraction Form. Data were entered, cleaned then analysed using SPSS version 25. Bivariate logistic regression was fitted. Adjusted odds ratio with 95% confidence interval was used to determine the statistical significance.

Findings: The incidence of primary postpartum haemorrhage was nearly 9.0% (95% CI: 6.91, 10.73). Of these, there was 7% maternal mortality. Predominant to women in Ethiopia health facility referrals of women in labour (AOR: 2.13; 95% CI: 1.19, 3.80), birth attended by a medical intern (AOR: 3.59; 95% CI: 1.89, 6.84), women who were discharged six hours following birth (AOR: 3.50; 95% CI: 1.24, 9.91) were associated with primary postpartum haemorrhage (p<0.05).

Conclusion: This study found that the reported incidence of primary postpartum haemorrhage was relatively low. However, the associated deaths of women found was comparatively high. Three factors prevail for women in Ethiopia, women discharged 6 hours postpartum, transfers from primary health centres, birth attendance by a medical intern.

Funding Statement: This study was unfunded.

Declaration of Interests: The authors declare that there are no conflicts of interest.

Ethics Approval Statement: Before commencing data collection ethics approval was sought and approved by Human Research Ethics Committee, Monash University (Project ID: 14113) on 24/08/2018 and Institutional Review Board for Human Research of the University of Gondar on December 20/2018. As the women were already discharged, and not all contactable in rural areas, they could not consent to this research retrospectively providing permission to the reviewing of their maternity care logbooks. The ethics committees granted a waiver of consent.