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Primary Postpartum Haemorrhage in Tasmania 1982–1986
Author(s) -
Allen D. G.,
Correy J. F.,
Marsden D. E.
Publication year - 1988
Publication title -
australian and new zealand journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.734
H-Index - 65
eISSN - 1479-828X
pISSN - 0004-8666
DOI - 10.1111/j.1479-828x.1988.tb01683.x
Subject(s) - caesarean section , medicine , obstetrics , vaginal delivery , episiotomy , incidence (geometry) , blood transfusion , blood loss , complication , postpartum haemorrhage , hysterectomy , pregnancy , surgery , genetics , physics , optics , biology
EDITORIAL COMMENT: This paper provides valuable statistics regarding the most common life‐threatening complication that occurs in the delivery room. The overall incidence of primary postpartum haemorrhage (PPH) was 7.2%, and the rate was significantly higher after either instrumental delivery (13.7%) or Caesarean section (15.4%), than after normal vaginal delivery (3.9%). This paper does not discuss the influence of episiotomy or retained placenta, and the authors do not tell us the method of management of the third stage of labour which they favour. Blood transfusion statistics are not quoted but the high incidence of PPH associated with Caesarean section, antepartum haemorrhage and multiple pregnancy, suggest that it is prudent to cross‐match blood in patients with these complications. In one hospital series of 15,860 deliveries (1) the incidence of PPH was 3.7% (excluding Caesarean sections unless blood loss exceeded 600 ml after the operation), and 1 in 3 patients with this complication received a blood transfusion, and 1 in 200 required hysterectomy. In this series there were 2,305 Caesarean sections and in these patients the blood transfusion rate was 8.3%, and 1 in 100 required hysterectomy. Postpartum haemorrhage and Caesarean section share a special association because, if blood loss is measured accurately at operation, the mean volume (± SD) is 1,290 ± 240 ml for first Caesarean section and 1,012 ± 380 ml for repeat operations (2). The presence of an episiotomy or perineal tear is also important, in terms of average blood loss, in patients delivered vaginally; Paull and Ratten (3) reported that, in both nulliparas and multiparas, the amount of blood loss more than doubled in patients with a sutured tear or episiotomy in comparison with those with an intact perineum. Estimation of blood loss at delivery is difficult, especially at Caesarean section. Because of this it is wise to perform a haemoglobin estimation in the puerperium — the results are often a surprise! It is the editor's practice to advise all patients to continue iron tablets for 3 months after delivery to minimize the risk of postpartum anaemia. Summary: Primary postpartum haemorrhage remains a significant problem in modern obstetric practice. The incidence and factors associated with postpartum haemorrhage in Tasmania over a 5‐year period were studied. The mode of delivery, anaesthesia, birth‐weight, induction and augmentation of labour, multiple pregnancy, antepartum haemorrhage and hypertension were found to be important factors. The incidence of retained placenta was not considered in this study.