EARLY IDENTIFICATION AND MANAGEMENT OF POSTPARTUM HEMORRHAGE IN THE LABOUR ROOM: A PROSPECTIVE OBSERVATIONAL STUDY

Abstract

Background: Postpartum hemorrhage (PPH) remains the leading single cause of maternal mortality worldwide. Early recognition and protocolized first-response management in the labour room are critical determinants of outcome. This study aimed to evaluate the incidence, risk factors, timeliness of recognition, and management of PPH in a tertiary-care labour room.

Methods: A prospective observational study was conducted over 12 months (July 2024–June 2025) among 1,500 consecutive deliveries. Blood loss was measured objectively using calibrated under-buttocks drapes. PPH was defined as blood loss ≥500 mL after vaginal birth or ≥1,000 mL after caesarean section within 24 hours. A structured data collection tool captured the "4 Ts" etiology, timing of each element of the first-response bundle, interventions, and maternal outcomes. Logistic regression identified independent risk factors.

Results: PPH occurred in 157 women (10.5%; 95% CI 8.9–12.0). The rate was higher after caesarean section than vaginal birth (13.3% vs 9.5%; p = 0.040). Uterine atony accounted for 72.0% of cases. Independent risk factors included retained placenta (aOR 30.0), previous PPH (aOR 5.6), anaemia (aOR 3.2), macrosomia (aOR 3.4), and multiple pregnancy (aOR 3.6). Recognition within 15 minutes occurred in 87.3% of cases; tranexamic acid was given within 30 minutes of diagnosis in 81.5%. A shock index ≥1 at diagnosis was strongly associated with severe PPH (OR 15.8, 95% CI 6.7–37.6). Early tranexamic acid was associated with lower odds of severe PPH (OR 0.14, 95% CI 0.06–0.33). Hysterectomy was required in 1.9% and one maternal death occurred (case fatality 0.64%).

Conclusions: Objective measurement enabled early detection, yet delays in escalation persisted. Structured, time-stamped bundles with early tranexamic acid and shock-index-guided triage are feasible in busy labour rooms and may reduce severe hemorrhage.