Incidence, Causes and Outcomes of Postpartum Hemorrhage in Eastern Ethiopia: A Multicenter Surveillance Study

Sagni Girma; Abera Kenay Tura; Redwan Ahmed; Marian Knight; Thomas van den Akker

doi:10.1007/s10995-024-03986-4

Incidence, Causes and Outcomes of Postpartum Hemorrhage in Eastern Ethiopia: A Multicenter Surveillance Study

Matern Child Health J. 2024 Sep 19. doi: 10.1007/s10995-024-03986-4. Online ahead of print.

Authors

Sagni Girma^{1

2}, Abera Kenay Tura^{3

4}, Redwan Ahmed⁵, Marian Knight⁶, Thomas van den Akker^{7

8}

Affiliations

¹ College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia. s.g.fage@lumc.nl.
² Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands. s.g.fage@lumc.nl.
³ College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
⁴ Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK.
⁵ Department of Obstetrics and Gynecology, Hiwot Fana Specialized University Hospital, Harar, Ethiopia.
⁶ National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
⁷ Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands.
⁸ Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.

PMID: 39298069
DOI: 10.1007/s10995-024-03986-4

Abstract

Objectives: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: Ethiopia; Maternal death; Obstetric surveillance; Postpartum hemorrhage.

Abstract

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