Pradeepa, B (2022) A Study on Risk Stratification of Antenatal Mothers at Term and Its Impact on Primary Postpartum Hemorrhage and Level of Management in each Risk Group. Masters thesis, Stanley Medical College, Chennai.
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Abstract
BACKGROUND: Postpartum haemorrhage (PPH) is a leading cause of maternal mortality and morbidity worldwide and 75-90% of these haemorrhage results from uterine atony. Delayed and substandard obstetrics care can kill a woman within hours of Major Obstetric Haemorrhage (MOH). Prenatal identification of at risk women, prompt assessment of blood loss, effective management and involvement of multidisciplinary teams is of utmost importance to save the lives of these women. The place of delivery and severity of haemorrhage determine the outcome. If the woman has developed PPH following delivery in a health facility, the immediate medical and surgical interventions are possible. It is not so, when woman delivers at home or in a small hospital ill equiped with facilities to manage obstetric emergencies. Diagnosis of PPH and decision to transfer to hospital or tertiary care centre is very crucial. Home deliveries and deliveries in small facilities have negative influence on the outcome. Crucial time is lost in transfer of patient to higher centres. At times patients are transferred as per transfer protocols of the health care centres, which may further cause delay as small health facilities, including primary health centres and rural hospitals are not equipped with desired specialist manpower and blood transfusion facilities. Although historically many definitions have been used, the American College of Obstetricians and Gynecologists’ revitalize program, in an effort to standardize clinical definitions in obstetrics, defines postpartum hemorrhage as blood loss greater than or equal to 1,000 mL or blood loss with signs or symptoms of hypovolemia within 24 hours of delivery whether cesarean section or vaginal birth OBJECTIVE OF THE STUDY: 1. To stratify AN patients into risk groups based on maternal clinical characteristics and medical history 2. To study it's impact on postpartum hemorrhage (PPH) and follow up the patients in each risk group and study the levels of management needed for the control of PPH. MATERIALS AND METHOD: This is a Descriptive longitudinal study where 500 cases were included in the study. PPH occurred in 34 cases. The study was conducted in Govt RSRM lying in hospital. The study spanned over a period of 1 year. The patients were selected based on inclusion and exclusion criteria. The relevant data were collected and analyzed. RESULTS: Among 500 patients, in the low risk category, out of 290 cases only 2 (0.69%) had PPH and that cases treated with level 1 management. In the medium risk category, out of 181 cases 25 (13%) had PPH and 19 cases treated with level 1 management and 6 cases treated with level 2 management. In the high risk category, out of 29 cases, 7 (24%) had PPH and 5 cases treated with level management, one case treated with level 2 management and only one cases goes to level 3 management. The correlation between risk stratification and it’s impact on outcome of PPH with P value <0.001 which shows highly statistical association between risk stratification and PPH and it’s outcome. This correlates with NHM guideline on risk stratification for PPH CONCLUSION: Thus in high risk group there was increased risk of PPH compared to medium and low risk patients. In my study only one case had gone for level 3 management. Therefore high risk patients should be identified earlier, promptly treated and early referral to tertiary care centre. Since my hospital is a tertiary care centre where senior obstetrician, anaesthesiologist, OT setup, Blood bank facility are available round the clock. Here high risk patients are identified and anticipated PPH in those patients and 2 unit PC would be crossmatched and kept ready and anaesthesiologist and OT staffs are informed prior. Thus reducing occurence of PPH and its complications and maternal mortality.
| Item Type: | Thesis (Masters) |
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| Additional Information: | 221916064 |
| Uncontrolled Keywords: | Risk Stratification, Antenatal Mothers, Primary Postpartum Hemorrhage, Level of Management, Risk Group. |
| Subjects: | MEDICAL > Obstetrics and Gynaecology > MEDICAL > Obstetrics and Gynaecology |
| Depositing User: | Subramani R |
| Date Deposited: | 03 May 2021 09:42 |
| Last Modified: | 03 Dec 2023 05:51 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/15703 |
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