Magnitude of postpartum hemorrhage and its associated factors in Ethiopia: a systematic review and meta-analysis

Abstract

Background: Postpartum hemorrhage or postpartum bleeding (PPH) is often defined as loss of > 500 ml of blood after vaginal delivery or > 1000 ml after cesarean delivery within 24 h. Postpartum hemorrhage is a leading direct cause of maternal morbidity and mortality in Ethiopia. Therefore, the main objective of this systematic review and meta-analysis was to estimate the pooled magnitude of postpartum hemorrhage and the pooled effect size of the associated factors in Ethiopia.

Methods: Primary studies were searched from PubMed/MEDLINE online, Science Direct, Hinari, Cochrane Library, CINAHL, African Journals Online, Google and Google Scholars databases. The searching of the primary studies included for this systematic review and meta-analysis was limited by papers published from 2010 to October 10/2021. The data extraction format was prepared in Microsoft Excel and extracted data was exported to Stata Version 16.0 statistical software for analysis. A random effect meta-analysis model was used. Statistical heterogeneity was evaluated by the I² test and Egger's weighted regression test was used to assess publication bias.

Result: A total of 21 studies were included in this meta-analysis. The pooled magnitude of postpartum hemorrhage in Ethiopia was 8.24% [(95% CI 7.07, 9.40]. Older age [OR = 5.038 (95% CI 2.774, 9.151)], prolonged labor [OR = 4.054 (95% CI 1.484, 11.074)], absence of anti-natal care visits (ANC) [OR = 13.84 (95% CI 5.57, 34.346)], grand-multiparty [OR = 6.584 (95% CI 1.902, 22.795)], and history of postpartum hemorrhage [OR = 4.355 (95% CI 2.347, 8.079)] were factors associated with the occurrence of postpartum hemorrhage.

Conclusions: The pooled magnitude of postpartum hemorrhage among post-natal mothers in Ethiopia was moderately high. The finding of this study will strongly help different stakeholder working in maternal and child health to focus on the main contributors' factors to reduce post-partum hemorrhage among postnatal mothers. Health professionals attending labor and delivery should give more attention to advanced aged mothers, grand-multipara mothers and mothers who had a history of post-partum hemorrhage due to higher risk for postpartum hemorrhage. Encouraging to continue ANC visit and prevent prolonged labor should also be recommended to decrease postpartum hemorrhage.

Keywords: Bleeding after birth; Ethiopia; Magnitude; Obstetric complications; Postpartum hemorrhage; Prevalence.

Fig. 1

PRISMA flow chart during the selection process for the studies included in the analysis

Fig. 2

Forest plot for the pooled magnitude of postpartum hemorrhage in Ethiopia, 2021

Fig. 3

Funnel plot showing symmetric distribution of articles on magnitude of post-partum hemorrhage in Ethiopia, 2021

Fig. 4

Sub-group analysis of magnitude of post-partum hemorrhage in Ethiopia by using regions, 2021

Fig. 5

Sub-group analysis of magnitude of post-partum hemorrhage in Ethiopia by using study area, 2021

Fig. 6

The pooled odds ratio of the association between age of the mother and post-partum hemorrhage in Ethiopia, 2021

Fig. 7

The pooled odds ratio of the association between prolonged labor and post-partum hemorrhage in Ethiopia, 2021

Fig. 8

The pooled odds ratio of the association between ant-natal care (ANC) follow-up and post-partum hemorrhage in Ethiopia, 2021

Fig. 9

The pooled odds ratio of the association between parity and post-partum hemorrhage in Ethiopia, 2021

Fig. 10

The pooled odds ratio of the association between history of previous PPH and post-partum hemorrhage in Ethiopia,2021