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

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.