Evaluation of Near-miss Cases associated with Post-partum Hemorrhage in Cumilla Medical College and Hospital

Author(s): Rezwan Sultana, Jasmin Ara Zaman, Afreen Kabir Kheya, Lizwana Nusrat Lia, Fathima Sultana.

Background: Near-miss obstetric cases are a new indicator of maternal care and could be used to compare improvements in treatment more accurately.

Aim of the study: The study aims to evaluate the near-miss cases associated with Post-Partum Hemorrhage (PPH) and to assess its sociodemographic factors.

Methods: This prospective observational study was conducted at the Department of Obstetrics and Gynecology in Cumilla Medical College Hospital for six months (February 2019-July 2019) after approval of the protocol. A total of 100 near-miss cases with a diagnosis of PPH admitted in the Gynae & Obs. ward were selected. Detailed history taking. Findings of the general and systemic examination, relevant investigations, treatment modalities and their outcome were collected in a predesigned data sheet.

Results: A total of 100 patients with near-miss cases associated with PPH were included in the study. The mean age of the patients was 25.694.63 years. Among the study population, 25% were illiterate, and 60% were second-grade. The mean gestational age of the patients was 38+ weeks. 73% had a standard vaginal delivery, and 27% underwent a caesarian section. Most of the delivery (62%) was conducted by an untrained person at home. The maternal mortality rate was 6% due to irreversible shock. In 62% of cases, the primary cause of PPH was uterine atony, 18% of cases retained placenta, 14% of cases had trauma, and the rest, 6% cases had mixed causes.

Conclusion: The results indicate that regular antenatal care (ANC) and the conduction of delivery by skilled birth attendants can reduce the risk of PPH. PPH-associated mortality and morbidity can be prevented by critical judgment, early referral, and effective management.