Prevalence and Risk Factors of Primary Postpartum Hemorrhage after Vaginal Deliveries in the Bonassama District Hospital, Cameroon

Background: Approximately 800 women die from pregnancy-related conditions daily with 99% of these maternal deaths occurring in low resource countries. Primary postpartum haemorrhage accounts for 25.7% of maternal deaths in Africa. In Cameroon, primary postpartum hemorrhage remains the leading cause of maternal death.

Objective: The aim of this study was to determine the prevalence, risk factors, and the maternal and fetal outcomes of primary postpartum hemorrhage in the Bonassama District Hospital, Douala, Cameroon.

Methods: This study was a cross-sectional study. Of the 556 women interviewed regarding their willingness to participate in the study, 550 consented. Quantification of blood loss was done over the 24 hours using a 700cc measuring cylinder, an electronic weighing balance and the Pathfinder International wall chart for visual estimation of blood loss. The well-being of the neonates was evaluated by a pediatrician. Data was collected using a structured questionnaire and analyzed using EPI-INFOTM version 7.1.4.0. A P-value <0.05 used to determine association between variables was considered statistically significant.

Results: The prevalence of primary postpartum hemorrhage was 23.6%. The risk factors of primary postpartum hemorrhage were: previous postpartum hemorrhage (aO.R=6.50; 95% C.I=4.60-9.20), multiparity (aO.R=7.02; 95% C.I=5.27-8.02), prolonged labor (aO.R= 1.1; 95% C.I=1.01-6.61) and macrosomia (aO.R=8.18; 95% C.I= 5.53-8.51). The main causes of PPH were uterine atony and obstetrical lacerations (P-value<0.01). Two (1.5%) maternal and 2 (0.4%) perinatal deaths were recorded.

Conclusion: The prevalence of postpartum hemorrhage was high. The main cause of primary post-partum hemorrhage was uterine atony. Primary PPH was associated with uterine hypotonia, placenta retention and genital lacerations. The maternal and perinatal mortality were high. These findings highlight the pressing need for good quality emergency obstetric care and the availability of more accurate techniques of postpartum blood loss measurement. Secondly, hospitals need blood banks to manage patients with severe hemorrhage.