Risk factors for postpartum haemorrhage in the Northern Province of Rwanda: A case control study

Area of Science:

• Obstetrics and Gynecology
• Maternal Health
• Epidemiology

Background:

• Postpartum haemorrhage (PPH) is a leading cause of maternal mortality globally.
• Timely assessment and prevention of PPH risk factors are crucial during antenatal, intrapartum, and postpartum periods.
• This study focuses on identifying and modeling PPH risk factors in Rwanda.

Purpose of the Study:

• To investigate and model the primary risk factors associated with postpartum haemorrhage (PPH) in Rwanda.
• To identify key predictors for PPH to inform prevention strategies.
• To contribute to reducing maternal morbidity and mortality related to PPH.

Main Methods:

• An observational case-control study was conducted with 430 women (108 cases, 322 controls) at ≥32 weeks gestation in Rwanda.
• Primary PPH was defined by blood loss assessment or need for transfusion within the first hour postpartum.
• Poisson regression was used to estimate risk ratios for associated factors.

Main Results:

• The prevalence of primary PPH was 25.2%.
• Significant risk factors included antepartum haemorrhage (RR 3.36), multiple pregnancy (RR 1.83), and hemoglobin <11 g/dL (RR 1.51).
• Intrapartum/postpartum causes were uterine atony (RR 6.70), retained tissues (RR 4.32), and genital lacerations (RR 2.14).

Conclusions:

• Uterine atony is the primary cause of PPH in this Rwandan cohort.
• Antepartum haemorrhage and intrauterine fetal death should be considered in PPH prediction models.
• Further large-scale studies are recommended to explore additional PPH risk factors.