Prevalence, characteristics, and outcomes of postpartum hemorrhage in a tertiary hospital in Tigray, Northern Ethiopia (2017–2021): retrospective descriptive study

BACKGROUND: Postpartum hemorrhage (PPH) is the major cause of maternal mortality and morbidity worldwide. Its burden is specifically significant in resource-limited settings. OBJECTIVE: The study aimed to assess the prevalence, characteristics, and outcomes of PPH in a tertiary hospital in Tigray, northern Ethiopia, between January 1, 2017, and December 31, 2021. METHODS: This was a cross-sectional study. Data on prevalence, sociodemographic, obstetrics, clinical characteristics, management, and outcome of cases diagnosed with PPH were analyzed using descriptive statistics. RESULTS: During the 5-year study period, 23,090 deliveries were recorded at Ayder Comprehensive Specialized Hospital (ACSH). A total of 269 cases of PPH were treated, providing a prevalence of 1.17% with 95%CI 0.027-1.30 (11 per 1000 deliveries). Twelve incomplete charts were excluded. Primary PPH accounted for 220 (85.6%) of the known cases. Most PPH (53.7%) were diagnosed within 2 h after delivery. The estimated documented mean blood loss was 1,572.9 ml (SD = 914.3). The mean hemoglobin level before PPH and after PPH was 12.2 mg/dl and 7.8 mg/dl, respectively. Regarding management, non-pneumatic anti-shock garment (NASG) was used in 79(30.7%) cases, misoprostol in 144 (56%) cases, oxytocin in 125 (48.6%), and ergometrine in 15 (5.1%) cases. Laparotomy was performed in 59 (23%) cases, and hysterectomy was conducted in 40 (67.8%) of these cases. Organ dysfunction (renal failure) was recorded in 34 (13.2%) cases, 14 (5.4%) developed coagulation dysfunction, and 17 (6.6%) deaths. Seven (3.1%) cases were admitted to the intensive care unit (ICU). CONCLUSIONS AND RECOMMENDATIONS: The results of this study emphasized that PPH still poses a significant challenge for obstetric care in Tigray, Ethiopia. Considering the high case fatality rate, high prevalence of primary PPH, and atony, the practice of active management of the third stage of labor must be assessed, and corrective measures must be taken to institute proper protocols and practice.