Incidence of Postpartum Hemorrhage Among Women With Hypertensive Disorders in Pregnancy at Kenyatta National Hospital in 2019: a Prospective Cohort Study

Abstract

Background: Postpartum Hemorrhage (PPH) is the leading cause of maternal morbidity and mortality worldwide. PPH accounts for 35 % of all maternal deaths in low- and middle-income countries (LMIC) and 25 % in high income countries. Hypertensive disorders complicate 2-5% of pregnancies in high income countries while in LMIC it occurs in up to 8% depending on the region. In high income countries hypertensive diseases in pregnancy(HDP) are associated with a 2-3 fold increased risk of PPH. This increased risk of PPH may be attributed to HDP associated coagulopathy or thrombocytoepnia. Despite the high burden of PPH and HDP in LMIC especially in Kenya, the association between these two major causes of maternal mortality has not been studied. Objective: To compare the incidence and severity of PPH between hypertensive and normotensive women who delivered at Kenyatta National Hospital (KNH) between May and August 2019. Methodology: Study design: This was a prospective cohort study in which the exposed group were women with hypertensive disorders and the unexposed group were normotensive pregnant women who were admitted for delivery at KNH. Patients were followed up from admission, in labor and 48 hours after delivery. The main outcome was primary postpartum hemorrhage which was defined as blood loss of more than 500mls in a vaginal delivery and more than 1000 mls in a caesarian delivery, occurring within 24 hrs.’ after delivery. Severe PPH was defined as blood loss of more than 1500mls. PPH was assessed by the primary care giver during delivery by visual estimation. Site: The labor wards, antenatal wards and theater at KNH. Sample size: Total sample size was 420 participants, (211-normotensive), 209 hypertensive.........................................................................................................