Shirazee Hasibul Hasan, Saha Sudip Kr, Das Indrani, Mondal Tanmoy, Samanta Sandip, Sarkar Moloy
Department of Obstetrics and Gynaecology, Calcutta Medical College, Kolkata 700073.
J Indian Med Assoc. 2010 Oct;108(10):663-6.
To identify and analyse the risk factors associated with postpartum haemorrhage (PPH) and assess their impact on the maternal morbidity, a prospective observational study was carried out over a period of one year in a tertiary level referral institute in Kolkata, West Bengal, India. All the cases of PPH were identified and studied. Data analyses were done using Chi-square test. Out of 210 cases of maternal morbidity, 79 (37.6%) were found to have PPH as the causative factor. Uterine atonicity was found to be the main cause leading to 45 cases (56.9%) of PPH. With respect to the mode of delivery severe PPH was found in 34.3% of vaginally and 60% of operatively delivered patients which had statistical significance. More number of severe PPH cases, 17/31 (54.8%), had delivered outside the medical college. Here comes the role of 24-hour quality emergency obstetric care (EMOC), active management of 3rd stage of labour and early referral to the higher centre. The case fatality rate of PPH during the study period was 7.5%. This finding is quite close to the observation made in a North Indian tertiary hospital based study. In order to reduce maternal morbidity and thereby indirectly maternal mortality and to improve the overall maternal health, prevention and control of PPH can play a significant role. An integrated approach at all levels of healthcare delivery system, active management of labour and efficient emergency obstetric care will help in controlling the PPH.
为了识别和分析与产后出血（PPH）相关的危险因素，并评估其对孕产妇发病情况的影响，在印度西孟加拉邦加尔各答的一家三级转诊机构进行了为期一年的前瞻性观察研究。所有产后出血病例均被识别并进行研究。数据分析采用卡方检验。在210例孕产妇发病病例中，发现79例（37.6%）的病因是产后出血。子宫收缩乏力被发现是导致45例（56.9%）产后出血的主要原因。关于分娩方式，经阴道分娩的患者中34.3%发生严重产后出血，剖宫产分娩的患者中60%发生严重产后出血，具有统计学意义。更多严重产后出血病例，17/31（54.8%），是在医学院外分娩的。这凸显了24小时高质量紧急产科护理（EMOC）、积极处理第三产程以及早期转诊至上级中心的作用。研究期间产后出血的病死率为7.5%。这一发现与在北印度一家三级医院进行的研究观察结果非常接近。为了降低孕产妇发病率，从而间接降低孕产妇死亡率并改善整体孕产妇健康状况，预防和控制产后出血可发挥重要作用。在医疗保健提供系统的各个层面采取综合方法、积极处理分娩过程以及提供高效的紧急产科护理将有助于控制产后出血。
