Comparison of causes of postpartum haemorrhage following vaginal deliveries and caesarean sections in a tertiary care hospital of Pakistan

Aim: to review the causes of postpartum haemorrhage (pph) among vaginal and caesarean deliveries in a tertiary care teaching hospital of pakistan study design: descriptive retrospective study methods: the study was conducted in the department of obstetrics & gynaecology,lahore general hospital,lahore,from 1st january 2006 to 1st january 2009. the medical records of all the patients who had pph were reviewed and its cause was determined. the data was tabulated and analyzed statistically by spss version 20. the chi square test was used to establish association between the mode of delivery and pph,p value < 0.001 was taken as statistically significant. results: the total number of deliveries during the study period was 8713. out of these 215 had pph,the overall rate of pph was 2.46%. spontaneous vaginal deliveries (svds) occurred in 6025 cases,out of these 130 had pph (2.13%),while out of 2479 cesarean sections (c/ss) 72 developed pph (2.90 %). the instrumental vaginal deliveries were 159 and 13 had pph (8.16%). the leading cause of pph in svd and instrumental delivery group was genital tract trauma,whereas in caesarean section (c/s) group was uterine atony. severe intractable pph occurred mainly in c/s group i.e.,25 out of 27 cases and two expiries occurred. conclusion: pph is preventable by simple and cost effective measures. a careful decision making regarding the mode of delivery should be done and a regular audit of all cases of pph should be performed to determine strategies to reduce the morbidity and mortality.