Post-partum haemorrhage--a risk factor analysis

This case control study was done to analyze significance of various risk factors in post-partum haemorrhage (PPH). This study was conducted in the Department of Obstetrics and Gynaecology, Unit V, Dow University of Health Sciences & Lyari General Hospital, Karachi, Pakistan. Study period extended from 1st August 2005 to 31st March 2009. Cases were selected by non-probability sampling and included cases noted in the study unit as well as those admitted with PPH after delivery elsewhere. Controls were selected randomly from patients delivered during same study period who did not have PPH. Cause, type, severity and duration between delivery and onset of PPH were recorded. Amongst the demographic risk factors, age and parity were categorized into sub-groups. Obstetric risk factors were identified for presence or otherwise. Spearman test was used to see bivariate correlation between PPH and various risk factors. P value <0.05 was considered as significant. All the variables which significantly correlated with PPH were entered into logistic regression as cofactors and final risk assessment model was constructed. SPSS version 15 was used for data analysis. Sixty two patients with PPH were studied. Mean age of patients was 28.8 years and controls was 26.8 years (p=0.006). Mean parity of cases was 3.1, while that of controls was 2.15 (p=0.001). Mean Hb was 8.07g/dl in cases and 9.8g/dl in controls (p=0.000). Mean gestational age was equal in both groups. Most frequent cause of PPH was uterine atony, seen in 58.1%, while 17.7% patients had severe amount of haemorrhage. Secondary PPH was seen in 16.1% patients. Majority of events of PPH occurred immediately after delivery. Bivariate analysis of risk factors revealed age more than 35 years, high parity, moderate to severe anaemia, PPH in a previous pregnancy, polyhydramnios, placenta praevia, morbidly adherent placenta and home birth as significant risks. Final logistic regression model included only age >35 years, anaemia, previous history of PPH and home delivery as independent risk factors for PPH. Advanced age, moderate to severe anaemia, PPH in a previous pregnancy and home birth were identified as important risk factors for PPH.