Prevalence and associated factors of postpartum hemorrhage in Mothers who delivered bycesarean section at selected hospitals in Jimma zone, oromia region, south western ethiopia

Abstract

Background: Postpartum hemorrhage (PPH) is the leading direct cause of maternal mortality worldwide, responsible for more than a quarter of all maternal deaths. A third (32%) of all deaths following cesarean section is attributed to postpartum hemorrhage. Despite variations across studies and regions, excessivehemorrhage associated with caesarean section, occurs in more than 3-10% of caesarean sections.Only about one-third of PPH cases have identifiable risk factors suggesting that essentially every woman might be at risk.Overuse of CS worldwide and substandard care provision in low resource settings has, in turn, exacerbated incidence of post-operative complications such as bleeding, placental invasion anomalies, intra-abdominal adhesions. Importantly, 54-93% of maternal deaths from obstetric hemorrhage may be preventable. Objective : To determine magnitude, identify associated factors and assess maternal outcomes of postpartum hemorrhage. Methods : Facility-based cross-sectional study design was conducted at five purposefully selected hospitals in Jimma zone from December 09, 2020 to September 31, 2021: one referral and teaching hospital, three general hospitals and one primary hospital. Because there was no similar study done specifically on this topic, sample size was determined using epi Info version 7.1.1 with the following assumptions; Confidence level 95%, Margin of error 5%, and 50% proportion of mothers developing PPH at cesarean delivery was used.n=384. After adding 10% nonresponse rate the final sample size was n=422. Data was collected using a pretested structured questionnaire by clerking the patient and reviewing the patient’s chart and asking the operating physician and IESO surgeon about vague documentations that willbe filled by trainedOR nurse.Data was coded and entered using Epi-data version 4.6 and analysis was carried out using SPSS 26.0 version computer software. Results: The overall prevalence of PPH in mothers who delivered by cesarean section in this study was 18.2%.In the multivariable model, Hosmer–Lemeshow test, P = 0.6, mothers presented with APH[AOR=4.9;95% CI(1.1,21.8)], advanced stage of labor at decision[AOR=4.8;95% CI(1.3,17.8)] and difficulty in extracting fetal presenting part intra operatively[AOR= 22.8;95% CI(8.19,63.9)] were significant predictors of PPH during cesarean delivery. Uterine atony and uterine trauma/extension were the commonest causes of PPH during surgery in 42.9% and 35.1% of the deliveries respectively. Anemia, sepsis and shock secondary to bleeding were the most commonly identified morbidities that follow cesarean delivery. Conclusion: The study shows postpartum hemorrhage in mothers who deliveredby cesarean delivery is a quite common problem in the study area. Majority of the causes of PPH were avoidable with meticulous surgical technique and early recognition of risk factors and preparation to manage timely. 4 Recommendation: Knowledge and clinical skills in early decision making, surgical hemostasis techniques and stepwise medical and surgical management of PPH must be practiced especially in primary and general hospital setups. In addition,further large scale studies should be done both nationally and in Jimma zone to strengthen this study and design strategies.