title: The impact of primary postpartum hemorrhage in "near-miss" morbidity and mortality in a tertiary care hospital in North India.
abstract: OBJECTIVE
  To assess risk factors, mortality and "near-miss" morbidity in early PPH.
  
  
  METHODS
  Retrospective analysis of 178 women with early PPH (within 24 h of delivery) over 4 consecutive years in a tertiary care hospital in North India.
  
  
  METHODS
  All case sheets of patients identified by labor record registers as having early PPH were reviewed by the same person to identify the actual impact of condition. The data was analyzed by chi-square analysis.
  
  
  RESULTS
  Early PPH (loss of blood that caused significant alteration in maternal condition or blood loss 500 in vaginal deliveries or> 1000 cc in cesarean section) was recorded in 178; 90 delivered in hospital (Group-A) and 88 referred after delivery (Group-B) from various peripheral centers, i.e., maternity hospitals, nursing homes, district and community health centers. The maternal mortality ratio during this period was 1049/100,000 (139 deaths/13248 live births; direct maternal deaths = 94). Early PPH accounted for 11/94 direct maternal deaths (11.7%). Of these 11 deaths, 3 were in group A and 8 in group B. "Near-miss" morbidity was higher than mortality (Total 19/178; 5/90 in Group-A and 14/88 in Group-B). Delayed referral and lack of active 3rd stage management in Group-B were responsible for most of the adverse events.
  
  
  CONCLUSIONS
  Both "near-miss" morbidity and mortality in early PPH reflect the level of obstetric care in the developing world. These need to be reduced by strengthening peripheral delivery facilities, active 3rd stage management and early referral.
authors.affiliation: Department of Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research, Sector-12, Chandigarh - 160 012, India.
authors.forename: Virochana
authors.initials: V
authors.lastname: Kaul
authors.forename: Rashmi
authors.initials: R
authors.lastname: Bagga
authors.forename: Vanita
authors.initials: V
authors.lastname: Jain
authors.forename: Sarala
authors.initials: S
authors.lastname: Gopalan
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007194:India; D006473:Postpartum Hemorrhage / Q000209:etiology* / Q000401:mortality*; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors