Management and Maternal Outcomes of Primary Postpartum Hemorrhage: A Cross-Sectional Study at Wad Medani Maternity Teaching Hospital, Sudan

Abstract

Background: Primary postpartum hemorrhage (PPH) remains a leading cause of maternal morbidity and mortality worldwide, particularly in low-resource settings. Understanding its causes, associated risk factors, and management outcomes is essential for improving maternal health.

Objective: To assess the causes, risk factors, management modalities, and maternal outcomes of primary postpartum hemorrhage among women admitted to Wad Medani Maternity Teaching Hospital, Sudan.

Methods: A descriptive cross-sectional hospital-based study was conducted at Wad Medani Maternity Teaching Hospital, Sudan, from October 2020 to April 2021. A total of 211 women diagnosed with primary postpartum hemorrhage were included. Data were collected using a structured questionnaire and analyzed using SPSS.

Results: Uterine atony was the leading cause of primary postpartum hemorrhage (76.3%), followed by genital tract trauma (12.8%), retained placental tissue (10.0%), and coagulation disorders (0.9%). The most common risk factor was prolonged third stage of labor (74.9%), followed by episiotomy (10.4%), fetal macrosomia (6.2%), multiple pregnancy (4.7%), and previous history of postpartum hemorrhage (3.8%). Most cases (83%) were successfully managed medically, while 17% required surgical intervention. The most common surgical procedures were uterine compression sutures (16.1%), uterine artery ligation (14.7%), and hysterectomy (10.4%). The most frequent maternal complications were orthostatic hypotension (73.5%), anemia (33.6%), fatigue (25.6%), and dilutional coagulopathy (16.1%).

Conclusion: Uterine atony was the predominant cause of primary postpartum hemorrhage, and prolonged third stage of labor was the most significant associated risk factor. Most cases were effectively managed with medical treatment, highlighting the importance of early recognition and prompt intervention to reduce maternal morbidity.