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Background: Primary postpartum haemorrhage (PPPH) is the leading cause of maternal morbidity and mortality in low resource countries like Pakistan. The objectives of this study were to determine the frequency, distribution by place of delivery and parity, causes, management options and outcome of PPPH in postpartum women of District Peshawar, Pakistan. Materials & Methods: This cross-sectional study was conducted in Department of Gynaecology & Obstetrics, Lady Reading Hospital, Peshawar, Pakistan from 1st January 2019 to 30th June 2019. Sample size of 4,034 was with 0.39342% margin of error, 95% confidence level, prevalence of PPPH 2% and a population of 23,607 postpartum women. All postpartum women were eligible. Those with secondary PPH, surgical management for PPPH done at some other hospital, with known bleeding disorders and on anticoagulants were excluded. All these patients were managed according to standard protocols. Data was collected for following variables; presence of PPPH (yes/no), place of delivery (in-hospital deliveries/referred cases), parity (primipara/multipara/grandmultipara), causes of PPPH (uterine atony/retained placenta-RPOC/ruptured uterus/genital tract tears), management options of PPPH (conservative management/laparotomy with repair of ruptured uterus/laparotomy with uterine artery ligation and B-Lynch/repair of genital tract tears other than ruptured uterus/removal of retained placenta & RPOC/hysterectomy) and outcome of PPPH (uneventful recovery/maternal near miss/maternal mortality). Frequencies and percentages with confidence intervals were calculated for these variables. Results: Out of 4034 postpartum women, frequency of PPPH was 400 (9.92%). Out of 4034 women, distribution of 400 cases of PPPH by place of delivery was 222 (5.50%) in-hospital deliveries and 178 (4.42%) referred cases and by parity it was primipara 79 (1.96%), multipara 243 (6.03%) and grandmultipara 78 (1.93%) cases. Out of 400 cases of PPPH, frequency of uterine atony was 254 (63.50%) and conservative management 245 (61.25%). Out of 400 cases, frequency of uneventful recovery was 352 (88%), maternal near miss 40 (10%) and maternal mortality eight (2%) cases. Conclusion: Primary postpartum haemorrhage (PPPH) continues to be a common and serious complication of delivery with uterine atony being its most predominant cause. [ABSTRACT FROM AUTHOR]

Objective: The objective of our study is to determine the risk factors of primary post partum hemorrhage (PPH), so that its avoidable factors can be prevented. Design: Descriptive study. Place and Duration of Study: This prospective study was conducted in labour ward of Nawabshah hospital Sindh Pakistan from 5th April 2008 to 8th Dec 2008. Patients and Methods: Total of 121 patients were included in the study. Inclusion criteria were all patients admitted with or developed primary PPH in hospital after normal delivery or cesarean section. Exclusion criteria were patients with history of bleeding disorders and those on Heparin or Warfarin therapy. Patient's information was recorded on predesigned proforma. which includes sociodemographic data, mode of delivery, spontaneous, induced, delivery conducted by and risk factors for primary PPH. Assessment of general health including anemia, B.P, abdominal, pelvic examination and laboratory investigations were done. Results: A total of 121 cases of primary PPH were managed in study duration. Out of 121 patients majority 70(57.85 %) belongs to age group of 21-30 years. Regarding parity, 84 (69.42%) was grandmultipara, while 16 (13.22 %) patients were multipara. Majority of patients i.e. 71(58.67%) were unbooked, while 50(41.32%) were booked. 99(81.81%) patients were delivered in hospital. Regarding cause of PPH, uterine atony was identified as major cause seen in 98 (80.99%) of patients while genital tract injuries were seen in 23 (19%) of patients Commonest risk factor of PPH was grandmultiparity seen in 84 (69.42 %) of cases. Conclusion: Results of our study showed that unbooked, uterine atony, grandmultiparity, augmented and induced labor were commonest risk factors responsible for primary postpartum hemorrhage. [ABSTRACT FROM AUTHOR]

Objectives: To find out the use of Prostaglandin F2 alpha to avoid the surgical control of primary postpartum hemorrhage due to uterine atony and the adverse effects associated with prostaglandin F2 alpha. Material and Methods: This was a Quasi-Experimental study carried out in obstetrics & gynecology unit B of Khyber Teaching Hospital Peshawar from 1st July 2003 - 30th June 2004. 50 patients having primary post partum hemorrhage due to uterine atony not responding to conventional oxytocics were given systemic and local prostaglandin F2 alpha. Vital signs, estimated blood loss and effect on uterine muscular tone were noted before & after prostaglandin F2 alpha. Surgical interventions were used in patients with continuous profuse vaginal bleeding despite maximum dose of prostaglandin F2 alpha and/ or hemodynamic instability of the patients. A semi-structured proforma was used to collect the data. Results: A total of 44 (88%) patients responded well to the drug. Estimated blood loss before prostaglandin F2 alpha was 1000 - 4000ml with mean of 2250.00 + 686.98ml as compared to 416.00 + 294.41ml after prostaglandin F2 alpha was used. Side effects of the drug were mostly self limiting and required symptomatic treatment. No maternal death was recorded. Conclusion: Prostaglandin F2 alpha is an effective drug to control Primary post partum hemorrhage due to uterine atony and avoids surgical interventions in most of the patients. Side effects are minimum, most of which are self limiting. [ABSTRACT FROM AUTHOR]