Occurrence of post-partum hemorrhage in spontaneous versus induced labor in primigravida at term in a tertiary care hospital of Peshawar

Abstract

Introduction: Occurrence of post-partum hemorrhage (PPH) is a serious life-threatening complication of delivery and can occur with both normal vaginal delivery as well as induced labor. It is important to define the extent of blood loss after either procedure to adopt the safer method, particularly in complicated deliveries.

Objective: To compare the occurrence of post-partum hemorrhage in spontaneous and induced labor in primigravida at term at a tertiary care hospital of Peshawar.

Materials & Methods: This descriptive cross-sectional study was performed in Obstetrics and Gynecology Department (Gynae B unit), Lady Reading Hospital, Peshawar from 31/5/2019 to 31/11/2019. Total patients observed were 134. All women were subjected to complete history taking and detailed examination. Brief obstetrical history, period of gestation, mode of onset of labor and frequency of post-partum hemorrhage (more than 500 ml after vaginal delivery) were noted. Women were induced with prostaglandin E₂ gel only. The second gel was repeated after 6 hours if first attempt was failed. No more than three gels were used. Women were excluded from the study if they failed to go into labor even after the third gel. After vaginal delivery sanitary pads were used for blood loss estimation. They were weighed beforehand and after being soaked with blood, they were again weighed and the difference was noted as 1gm = 1ml. Descriptive statistics were done by SPSS 21.

Results: The mean age of subjects was 32 ± 3.90 years Forty two percent patients had BMI ≤25 and 58% patients had BMI >25. Seventy two percent of patients were having spontaneous labor and 28% were having induced labor. Twenty percent of patients had post-partum hemorrhage, 7% in spontaneous labor while 44% in induced labor, showing significant difference (p=0.03).

Conclusion: Post-partum hemorrhage occurred significantly more frequently in primigravid women at term undergoing induction of labor as compared to spontaneous labor.