College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands.
Matern Child Health J. 2024 Dec;28(12):2106-2114. doi: 10.1007/s10995-024-03986-4. Epub 2024 Sep 19.
Maternal mortality remains an unfinished global agenda and postpartum hemorrhage (PPH) remains one of the leading causes. The aims of this study were to describe the incidence, underlying causes, and case fatality rate of PPH in public hospitals in eastern Ethiopia.
This study was part of a larger Ethiopian Obstetric Surveillance System (EthOSS) project - a multicenter surveillance of women admitted to 13 public hospitals in eastern Ethiopia due to any of the five major obstetric conditions: obstetric hemorrhage, eclampsia, uterine rupture, sepsis, and severe anemia - conducted from April 1, 2021 to March 31, 2022. All registers in maternity units of those hospitals were reviewed to identify eligible women and collect data on sociodemographic and obstetric characteristics, management and maternal outcomes at discharge or death. Findings were reported using descriptive statistics.
Among 38,782 births registered during the study period, 2043 women were admitted with at least one of the five major obstetric conditions. Of these 2043, 306 women (15%) had PPH corresponding with an incidence rate of 8 (95% CI: 7-9) per 1000 births. Uterine atony was the main underlying cause in 77%; 81% of women with PPH received at least one uterotonic drug, and 72% of women for whom blood was requested received at least one unit. Of the 70 hospital based maternal deaths, 19 (27%) died from PPH, making a case fatality rate of 6 per 100.
Although the overall incidence of PPH appeared low, it was still the underlying cause of death in one out of four women who died. The contributing factors might be that one in five women with PPH did not receive any uterotonic drug and the low blood transfusion. Ongoing audit, followed by targeted action, is essential to improve care quality and reduce adverse maternal outcome. The relatively low incidence may reflect under-recording in paper-based records, implying that further research into methods to optimize the surveillance is needed.
产妇死亡仍然是一个未完成的全球议程，产后出血（PPH）仍然是主要原因之一。本研究旨在描述埃塞俄比亚东部公立医院产后出血的发生率、根本原因和病死率。
本研究是埃塞俄比亚产科监测系统（EthOSS）项目的一部分 - 对由于五种主要产科情况之一而入住埃塞俄比亚东部 13 家公立医院的妇女进行的多中心监测：产科出血、子痫、子宫破裂、败血症和严重贫血 - 于 2021 年 4 月 1 日至 2022 年 3 月 31 日进行。审查这些医院的产科病房的所有登记册，以确定符合条件的妇女，并收集关于社会人口学和产科特征、管理以及出院或死亡时的产妇结局的数据。使用描述性统计报告研究结果。
在研究期间登记的 38782 例分娩中，有 2043 例妇女因至少一种五种主要产科情况之一入院。在这 2043 例中，有 306 例（15%）患有 PPH，发病率为每 1000 例分娩 8 例（95%CI：7-9）。子宫收缩乏力是主要根本原因，占 77%；78%的 PPH 妇女至少接受了一种子宫收缩药物，要求输血的妇女中有 72%至少接受了一个单位的血液。在 70 例基于医院的产妇死亡中，19 例（27%）死于 PPH，病死率为每 100 例 6 例。
尽管 PPH 的总体发生率似乎较低，但它仍然是四分之一死于的妇女的死亡根本原因。促成因素可能是五分之一的 PPH 妇女未接受任何子宫收缩药物，以及低输血。持续进行审计，然后采取有针对性的行动，对于提高护理质量和降低不良产妇结局至关重要。相对较低的发生率可能反映了纸质记录中的记录不足，这意味着需要进一步研究优化监测的方法。
