DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20205767

Impact of increase of caesarean section on postpartum hemorrhage in a tertiary care center of India over 6 years

Shikha Madan, Neetu Sangwan, Smiti Nanda, Daya Sirohiwal, Pushpa Dahiya, Savita Singhal, Tarun Arora

Abstract


Background: PPH (postpartum hemorrhage) is the leading cause of maternal mortality. Despite of all the medical advancement, maternal mortality rates have declined greatly in the developed world, PPH remains a leading cause of maternal mortality elsewhere. Caesarean section is an obstetric intervention where, normal delivery can pose a risk for mother or foetus. The rate of caesarean section has increased worldwide. A survey conducted by WHO found that the worldwide rate of caesarean section increased from 26.4% between 2004 to 2008, to 31.2% between 2010 to 2011.

Methods: We collected data of the caesarean sections and patients who developed PPH over 6 years. We studied the association of temporal increase of caesarean section with PPH.

Results: Uterine atonicity continues to be the most common etiology of PPH each year, however, there is an increase in tissue abnormality (retained placenta, placenta praevia, accreta, increta, percreta) over years as there is a significant increase in the incidence of caesarean section. Atonic uterus was the most common cause for obstetric hysterectomies and mortality due to PPH every year.

Conclusions: Family planning advise is essential in developing country like ours to counsel patients to prevent multiparity, thus reducing PPH. It is also important to train all the health workers in periphery and referral centers to manage the third stage of labor and atonic uterus to save the mothers. Sagacious attitude towards the decision of caesarean section is needed to prevent maternal morbidity and mortality.


Keywords


Caesarean section, Postpartum hemorrhage, Tissue abnormality

Full Text:

PDF

References


Vogel JP, BetrĂ¡n AP, Vindevoghel N, Souza JP, Torloni MR, Zhang J, et al. WHO Multi-Country Survey on Maternal and Newborn Health Research Network. Use of the Robson classification to assess caesarean section trends in 21 countries: a secondary analysis of two WHO multicountry surveys. Lancet Glob Health. 2015;3(05):e260-70.

Special Bulletin of Maternal Mortality in India 2016-18. Office Of The Registrar General, India. Available from: https://censusindia.gov.in/ vital_statistics/SRS_Bulletins/MMR%20Bulletin%202016-18.pdf

Vogel JP, Williams M, Gallos I, Althabe F, Oladapo OT.. WHO recommendations on uterotonics for postpartum haemorrhage prevention: what works, and which one? BMJ Glob Health. 2019;4:e001466.

B Chalmers. Appropriate technology for birth. Br J Obstet Gynaecol. 1992;99(9):709-10.

World Health Organization. WHO statement on caesarean section rates. Geneva: World Health Organization; 2015. Available from: https://www.who.int/reproductivehealth/publications/maternal_perinatal_health/cs-statement/en/.

World Population prospects- Population division. United Nations Department of Economic and Social Affairs, Population Division. Available from: https://population.un.org/wpp/. Accessed on 9 November 2019.

Overall total population- World Population Prospects: The 2019 Revision. population.un.org (custom data acquired via website). United Nations Department of Economic and Social Affairs, Population Division. Retrieved 9 November 2019.

Population growth (annual %) World Bank. Retrieved 20 January 2015. Available from: https://data.worldbank.org/indicator/SP.POP.GROW.

Rajeshwari, Sreelatha S, Shruthi K, Kumar S, Shruthi A, Malpurae P. A study on risk factors of postpartum hemorrhage. New Indian J OBGYN. 2020;6(2):83-6.

Devi KP, Singh LR, Singh LB, Singh MR, Singh NN. Postpartum hemorrhage and maternal deaths in North East India. Open J of Obstet Gynaecol. 2015;5:635-8.

Kramer MS, Berg C, Abenhaim H, Dahhou M, Rouleau J, Mehrabadi A, et al. Incidence, risk factors, and temporal trends in severe postpartum hemorrhage. Am J Obstet Gynecol. 2013;209:449e1-7.

Sosa CG, Althabe F, Belizan JM, Buekens P. Risk factors for postpartum hemorrhage in vaginal deliveries in a Latin-American population. Obstet Gynecol 2009;113:1313-9.

Silver RM, Landon MB, Rouse DJ, Leveno KJ, Spong CY, Thom EA, et al. Maternal morbidity associated with multiple repeat cesarean deliveries. National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Obstet Gynecol. 2006;107:1226-32.