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Title: Haemato-Biochemical Parameters of Women Presenting With Primary Postpartum Haemorrhage (PPH) at the Komfo Anokye Teaching Hospital
Authors: Osakunor, Derick Nii Mensah
Issue Date: 4-Dec-2013
Abstract: Introduction: Among the various causes of maternal mortality, Postpartum Haemorrhage (PPH) has historically been and remains the single most important factor. The current study sought to identify certain antepartum parameters which may be associated with primary PPH and may have utility for screening and clinical management among women. It also sought to evaluate visual estimation as a method of diagnosis of primary PPH. Methods: This nested case-­‐‑control study consisted of 345 women at term, recruited at random from the KATH, O & G department, Kumasi from April to October 2012. 55 women developed primary PPH after vaginal delivery (cases), 216 women, after vaginal delivery did not develop primary PPH (controls) and 74 went through cesarean section (excluded). A questionnaire was administered to gather information on demography, anthropometry, clinical and obstetric history. Blood samples were taken for haematological and biochemical studies. Results: Prevalence of primary PPH was 15.8%. Visual estimation (250mls), upon comparison with direct measurement (306mls) underestimated blood loss by about 56mls and thus primary PPH by about 3.5%. Univariate analysis showed AST (P=0.043), ALB (P=0.001), URE (P<0.001), CRE (P=0.002), URE/CRE ratio (P=0.014), HGB/anaemia (P<0.001), ABO blood type (P=0.002), HCT (P<0.001), WBC (P=0.023), ESR (P=0.018) and Blood film picture (P<0.001) to be associated with primary PPH. After adjustment by multivariate analysis five factors remained significant. Increasing CRE, incresing URE/CRE ratio and decreasing HGB (<10g/dL) were associated with a higher likelihood of dveloping primaryPPH. Non-­‐‑O blood groups (A nd B positive) were associated with a less likelihood of developing primary PPH. iii Conclusion: Many antepartum and laboratory parameters are associated with primary PPH but only a few have screening utility. We however conclude that a total clinical work-­‐‑up, including a laboratory evaluation of the independent variables identified in this study could help a great deal in identifying individuals at high risk. Visual estimation of blood loss after vaginal delivery is unreliable and has a huge tendency to underestimate primary PPH and its consequences.
Description: A thesis submitted to the Department of Molecular Medicine, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, in partial fulfillment of the requirements for the degree of Master of Philosophy, September-2013
URI: http://hdl.handle.net/123456789/5342
Appears in Collections:College of Health Sciences

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