BJOG : an international journal of obstetrics and gynaecology · 2024
Burden and outcomes of postpartum haemorrhage in Nigerian referral-level hospitals.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Adebayo Tajudeen, Adefemi Ayodeji, Adewumi Idowu, Akinajo Opeyemi, Akinkunmi Bola, Awonuga David, Aworinde Olufemi, Ayegbusi Ekundayo, Dedeke Iyabode, Fajolu Iretiola, Imam Zainab, Jagun Olusoji, Kuku Olumide, Ogundare Ezra, Oluwasola Timothy, Oyeneyin Lawal, Adebanjo-Aina Damilola, Adenuga Emmanuel, Adeyanju Alaruru, Akinsanya Olufemi, Campbell Ibijoke, Kuti Bankole, Olofinbiyi Babatunde, Salau Qasim, Tongo Olukemi, Ezekwe Bosede, Lavin Tina, Oladapo Olufemi T, Tukur Jamilu, Adesina Olubukola
Аннотация
OBJECTIVE: To determine the prevalence of primary postpartum haemorrhage (PPH), risk factors, and maternal and neonatal outcomes in a multicentre study across Nigeria.
DESIGN: A secondary data analysis using a cross-sectional design.
SETTING: Referral-level hospitals (48 public and six private facilities).
POPULATION: Women admitted for birth between 1 September 2019 and 31 August 2020.
METHODS: Data collected over a 1-year period from the Maternal and Perinatal Database for Quality, Equity and Dignity programme in Nigeria were analysed, stratified by mode of delivery (vaginal or caesarean), using a mixed-effects logistic regression model.
MAIN OUTCOME MEASURES: Prevalence of PPH and maternal and neonatal outcomes.
RESULTS: Of 68 754 women, 2169 (3.2%, 95% CI 3.07%-3.30%) had PPH, with a prevalence of 2.7% (95% CI 2.55%-2.85%) and 4.0% (95% CI 3.75%-4.25%) for vaginal and caesarean deliveries, respectively. Factors associated with PPH following vaginal delivery were: no formal education (aOR 2.2, 95% CI 1.8-2.6, P < 0.001); multiple pregnancy (aOR 2.7, 95% CI 2.1-3.5, P < 0.001); and antepartum haemorrhage (aOR 11.7, 95% CI 9.4-14.7, P < 0.001). Factors associated with PPH in a caesarean delivery were: maternal age of >35 years (aOR 1.7, 95% CI 1.5-2.0, P < 0.001); referral from informal setting (aOR 2.4, 95% CI 1.4-4.0, P = 0.002); and antepartum haemorrhage (aOR 3.7, 95% CI 2.8-4.7, P < 0.001). Maternal mortality occurred in 4.8% (104/2169) of deliveries overall, and in 8.5% (101/1182) of intensive care unit admissions. One-quarter of all infants were stillborn (570/2307), representing 23.9% (429/1796) of neonatal intensive care unit admissions.
CONCLUSIONS: A PPH prevalence of 3.2% can be reduced with improved access to skilled birth attendants.
DESIGN: A secondary data analysis using a cross-sectional design.
SETTING: Referral-level hospitals (48 public and six private facilities).
POPULATION: Women admitted for birth between 1 September 2019 and 31 August 2020.
METHODS: Data collected over a 1-year period from the Maternal and Perinatal Database for Quality, Equity and Dignity programme in Nigeria were analysed, stratified by mode of delivery (vaginal or caesarean), using a mixed-effects logistic regression model.
MAIN OUTCOME MEASURES: Prevalence of PPH and maternal and neonatal outcomes.
RESULTS: Of 68 754 women, 2169 (3.2%, 95% CI 3.07%-3.30%) had PPH, with a prevalence of 2.7% (95% CI 2.55%-2.85%) and 4.0% (95% CI 3.75%-4.25%) for vaginal and caesarean deliveries, respectively. Factors associated with PPH following vaginal delivery were: no formal education (aOR 2.2, 95% CI 1.8-2.6, P < 0.001); multiple pregnancy (aOR 2.7, 95% CI 2.1-3.5, P < 0.001); and antepartum haemorrhage (aOR 11.7, 95% CI 9.4-14.7, P < 0.001). Factors associated with PPH in a caesarean delivery were: maternal age of >35 years (aOR 1.7, 95% CI 1.5-2.0, P < 0.001); referral from informal setting (aOR 2.4, 95% CI 1.4-4.0, P = 0.002); and antepartum haemorrhage (aOR 3.7, 95% CI 2.8-4.7, P < 0.001). Maternal mortality occurred in 4.8% (104/2169) of deliveries overall, and in 8.5% (101/1182) of intensive care unit admissions. One-quarter of all infants were stillborn (570/2307), representing 23.9% (429/1796) of neonatal intensive care unit admissions.
CONCLUSIONS: A PPH prevalence of 3.2% can be reduced with improved access to skilled birth attendants.