Incidence, treatment and outcomes of postpartum haemorrhage among women admitted at a large regional referral hospital in eastern Uganda: a one-year prospective observational study

Abstract

Background: Postpartum haemorrhage (PPH) is the leading cause of maternal mortality in Africa. We studied the incidence, treatment and outcomes of PPH in a large referral hospital in eastern Uganda.

Methods: This was a prospective observational study including women admitted to a referral hospital for obstetric care, with in-hospital PPH as the primary outcome and in-hospital mortality as secondary outcome. Data were collected through direct observation on 166 randomly selected days. Multivariable analysis using logistic regression was conducted to determine risk factors for PPH.

Results: We recruited 22.0% (2,358/10,842) of all women delivering at the hospital from February 2021 to March 2022; PPH rate was 7.1% (167/2,358) and was associated with greater maternal mortality (4/167 (2.4%) with PPH vs. 2/2,191 (0.1%) without PPH; OR 26.9 [4.9-147.9]; P <0.0001). In multivariable analysis, preeclampsia (OR 2.25 [1.1-4.6]; P = 0.027) and twin pregnancy (OR 3.2 [1.7-6.2]; P <0.001) were associated with increased risk of PPH while caesarean delivery (OR 0.5 [0.3-09]; P = 0.009) and delivery between 4-10 pm (OR 0.6 [0.4-0.9]; P = 0.032) were associated with a reduced risk. There were 448 women (including 281 delivered elsewhere) treated for PPH; 3.3% were treated by an obstetrician at the bedside, 44.0% could have immediately received blood and 47.0% tranexamic acid if needed.

Conclusions: One in 14 women delivered at a large Ugandan hospital developed PPH. Rates of PPH and death are far higher than in high-income countries. Our findings highlight staffing shortages and supply chain failures that impact the management of PPH.

Keywords: Maternal mortality; Observational study; Postpartum haemorrhage; Risk factors.