Abstract Number: OC 52.3
Meeting: ISTH 2022 Congress
Background: Maternal mortality in sub-Saharan Africa is ~500 to 1,000 per 100,000 live births (vs. ~5-20 in developed countries). Postpartum hemorrhage (PPH) is responsible for 30% to 50% of the deaths.
Aims: To study PPH, risk factors, and mortality in metropolitan Mozambique to inform future studies and intervention strategies.
Methods: Prospective data collection of deliveries at Maputo Central Hospital between February 2019 and January 2021. Data included age, HIV status, parity, delivery mode, delivery notes, vital signs, laboratory values, and fetal data. PPH was determined by charted diagnosis, blood loss >500 mL, transfusion, and/or notes indicating significant bleeding.
Results: 8,799 deliveries were analyzed. Median age and parity were 28 (Inter-quartile range [IQR] 24-32) and 1 (IQR 0-2). Prevalence of HIV and anemia was 10% and 57% respectively. Incidence of PPH and maternal mortality was 14.5% and 1.3% respectively. Maternal mortality was strongly associated with PPH (adjusted odds ratio [AOR] 4.27; 95% confidence interval [CI] 2.56-7.14), fewer gestational weeks (AOR .75; CI .71-.79), and rural living (AOR 1.84; CI 1.09-3.11). Uterine atony (UA; 1% prevalence) was associated with a strikingly high incidence of PPH (96.1%) and maternal mortality (8.8%). Parity of 5+ was associated with sharp increases in risk of PPH, maternal and infant mortality, and UA. Available labs from 1,202 distressed mothers revealed that lower hemoglobin level was strongly associated with PPH (AOR .75; CI .68-.81), especially evident with shorter gestation. PPH was also associated with eclampsia (AOR 3.87; CI 2.94-5.12). Blood product transfusions were available for only ~1/3 of PPH cases. Antifibrinolytics were unavailable.
Conclusion(s): PPH remains a serious problem with high mortality even in metropolitan areas of sub-Saharan Africa. Anemia is an important and modifiable risk factor (iron supplementation, prophylactic antifibrinolytics). It is critical to raise awareness and improve region-specific prevention protocols.
To cite this abstract in AMA style:Glenzer M, Barnes R, Correia M, Luis E, Boaventura I, Nhantumbo V, Manguele N, Silva P, von Drygalski A. Post-Partum Hemorrhage in Sub-Saharan Africa – First Results from a Prospective Study in Mozambique [abstract]. https://abstracts.isth.org/abstract/post-partum-hemorrhage-in-sub-saharan-africa-first-results-from-a-prospective-study-in-mozambique/. Accessed October 1, 2023.
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