Burden and outcomes of postpartum haemorrhage in Nigerian referral‐level hospitals
Tajudeen Adebayo, Ayodeji Adefemi, Idowu Adewumi, Opeyemi Akinajo, Bola Akinkunmi, David Awonuga, Olufemi Aworinde, Ekundayo Ayegbusi, Iyabode Dedeke, Iretiola Fajolu, Zainab Imam, Olusoji Jagun, Olumide Kuku, Ezra Ogundare, Timothy Oluwasola, Lawal Oyeneyin, Damilola Adebanjo‐Aina, Emmanuel Adenuga, Alaruru Adeyanju, Olufemi Akinsanya, Ibijoke Campbell, Bankole Kuti, Babatunde Olofinbiyi, Qasim Salau, Olukemi Tongo, Bosede Ezekwe, Tina Lavin, Olufemi T. Oladapo, Jamilu Tukur, Olubukola AdesinaAbstract
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.