Prevalence and predictors of primary postpartum hemorrhage: An implication for designing effective intervention at selected hospitals, Southern Ethiopia

Autoři: Biruk Assefa Kebede aff001;  Ritbano Ahmed Abdo aff001;  Abebe Alemu Anshebo aff001;  Beminet Moges Gebremariam aff002
Působiště autorů: Department of Midwifery, College of Medicine and Health Sciences, Wachemo University, Hossana, Ethiopia aff001;  Department of Public Health Officer, College of Medicine and Health Sciences, Wachemo University, Hossana, Ethiopia aff002
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: 10.1371/journal.pone.0224579



Primary postpartum hemorrhage is the leading cause of maternal mortality worldwide. Ethiopia has made significant progress in maternal health care services. Despite this, primary postpartum hemorrhage continues to remain the leading cause of maternal mortality in Ethiopia. This study aimed to assess the prevalence and predictors of primary postpartum hemorrhage among mothers who gave birth at selected hospitals in the Southern Ethiopia.


An institution-based cross-sectional study was employed from March 2–28, 2018. Four hundred and twenty-two study participants were obtained using the consecutive sampling method. A structured interviewer-administered questionnaire and chart review were used to collect data. Data were entered into Epi-data version 3.1 and analyzed using SPSS version 22. Multivariable logistic regression were used to determine the predictors of primary postpartum hemorrhage with 95% CI and p-value < 0.05.


The overall prevalence of primary postpartum hemorrhage was 16.6%. Mothers aged 35 and above [AOR = 6.8, 95% CI (3.6, 16.0)], pre-partum anemia [AOR = 5.3, 95% CI (2.2, 12.8)], complications during labor [AOR = 1.8, 95% CI (2.8, 4.2)], history of previous postpartum hemorrhage [AOR = 2.7, 95% CI (1.1, 6.8)] and instrumental delivery [AOR = 5.3, 95% CI (2.2, 12.8)] were significant predictors of primary postpartum hemorrhage.


Primary postpartum hemorrhage is quite common in the study area. Mothers aged 35 and above, complications during labor, history of previous postpartum hemorrhage, and instrumental delivery were predictors of primary postpartum hemorrhage. Since postpartum hemorrhage being relatively common, all obstetrics unit members should be prepared to manage mothers who experience it.

Klíčová slova:

Anemia – Birth – Hypertensive disorders in pregnancy – Labor and delivery – Obstetrics and gynecology – Postpartum hemorrhage – Pregnancy complications – Labor history


1. Dutta DC. Textbook of Obstetrics. Including Perinatology and Contraception. New Delhi: Jaypee Brothers Medical Publishers (P) Ltd. 2013, 7ed.

2. Say L, Chou D, Gemmill A, Tunçalp Ö, Moller A-B, Daniels J, et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health 2014; 2: e323–33. doi: 10.1016/S2214-109X(14)70227-X 25103301

3. Sheldon WR, Blum J, Vogel JP, Souza JP, Gulmezoglu AM, Winikoff B, et al. Postpartum haemorrhage management, risks, and maternal outcomes: findings from the World Health Organization Multicounty Survey on Maternal and Newborn Health. BJOG 2014; 121(1): 5–13.

4. Lutomski J, Byrne B, Devane D, Greene R. Increasing trends in atonic postpartum haemorrhage in Ireland: An 11-year population based cohort study. BJOG 2012; 119:306–314. doi: 10.1111/j.1471-0528.2011.03198.x 22168794

5. Nakagawa K, Yamada T, Cho K, Akaishi R, Kohgo Y, Hanatani K, et al. Independent Risk Factors for Postpartum Haemorrhage. Critical Care Obstetrics and Gynecology 2016; 2(2):10.

6. Goueslard K, Revert M, Iacobelli S, Cotenet J, Roussot A, Combier E, et al. Incidence and Risk Factors of Severe Post-Partum Haemorrhage: A Nationwide Population-Based Study from a Hospital Database. Quality in Primary Care 2017; 25 (2): 55–62.

7. Halle-Ekane GE, Emade FK, Bechem NN, Palle JN, Fongaing D, Essome H, et al. Prevalence and Risk Factors of Primary Postpartum Hemorrhage after Vaginal Deliveries in the Bonassama District Hospital, Cameroon. International Journal of Tropical Disease & Health 2016; 13(2): 1–12.

8. Dunning T, Harris JM, Sandall J. Women and their birth partners’ experiences following a primary postpartum haemorrhage: a qualitative study. BMC Pregnancy Childbirth 2016; 16:80. doi: 10.1186/s12884-016-0870-7 27089951

9. Tasneem F, Sirsam S, Shanbhag V. Clinical study of post-partum haemorrhage from a teaching hospital in Maharashtra, India. Int J Reprod Contracept Obstet Gynecol. 2017; 6(6):2366–2369.

10. Ngwenya S. Postpartum hemorrhage: incidence, risk factors, and outcomes in a low-resource setting International Journal of Women’s Health 2016:8 647–650. doi: 10.2147/IJWH.S119232 27843354

11. Frass KA. Postpartum hemorrhage is related to the hemoglobin levels at labor: Observational study. Alexandria Journal of Medicine 2015.

12. Ifeadike CO, Eleje GU, Umeh US, Okaforcha EI. Emerging trend in the etiology of postpartum hemorrhage in a low resource setting. J Preg Neonatal Med 2018; 2(2):34–40.

13. Edwards HM. Causes and predictors of postpartum blood loss: a cohort study. PhD thesis, University of Copenhagen, September 2016. Available at: postpartum-ph.d.-afhandling-Hellen-Edwards-FINAL-Print.pdf

14. Kebebush A. Magnitude, associated factors and maternal outcome of postpartum hemorrhage at Black Lion Specialized Hospital from Jan.1, 2009 TO Dec.30, 2013. MSc. Thesis, the University of Addis Ababa, June 2014. Available at: http://localhost:80/xmlui/handle/123456789/1892

15. Bateman BT, Berman MF, Riley LE, Leffert LR. The epidemiology of postpartum hemorrhage in a large, nationwide sample of deliveries. Anesth Analg 2010; 110:1368–73. doi: 10.1213/ANE.0b013e3181d74898 20237047

16. James AH, McLintock C, Lockhart E. Postpartum hemorrhage: when uterotonics and sutures fail. Am J Hematology2012; 87:S16–22.

17. Nyfløt LT, Sandven I, Stray-Pedersen B, Pettersen S, Al-Zirqi I1, Rosenberg M, Jacobsen AF, and Vangen S. Risk factors for severe postpartum hemorrhage: a case-control study. BMC Pregnancy and Childbirth 2017; 17:17. doi: 10.1186/s12884-016-1217-0 28068990

18. Ononge S, Mirembe F, Wandabwa J and Campbell Oona M. R. Incidence and risk factors for postpartum hemorrhage in Uganda. Reproductive Health 2016; 13:38. doi: 10.1186/s12978-016-0154-8 27080710

19. Tort J, Rozenberg P, Traoré M, Fournier P and Dumont A. Factors associated with postpartum hemorrhage maternal death in referral hospitals in Senegal and Mali: a cross-sectional epidemiological survey. BMC Pregnancy and Childbirth 2015; 15:235. doi: 10.1186/s12884-015-0669-y 26423997

20. Abdul-Kadir R, McLintock C, Ducloy AS, El-Refael H, England A, Federici AB, et al. Evaluation and management of postpartum hemorrhage: Consensus from an international expert panel. Transfusion 2014; 54:1756–68. doi: 10.1111/trf.12550 24617726

21. Huang YY, Bao YR, Qu X, Yuan L, Ying H. Factors associated with different levels of postpartum hemorrhage in patients experiencing blood transfusion during cesarean section. Int J Clin Exp Med 2016; 9(8):16675–16681.

22. Kramer MS, Dahhou M, Vallerand D, Liston R,. Joseph KS. Risk Factors for Postpartum Hemorrhage: Can We Explain the Recent Temporal Increase?. J Obstet Gynaecol Can 2011;33(8):810–819. doi: 10.1016/S1701-2163(16)34984-2 21846436

23. Traoré Y, Téguété I, Bocoum A, Traoré M Dao S, Bomini MK, et al. Management and Prognosis of Early Postpartum Hemorrhage in African Low Setting Health. Open Journal of Obstetrics and Gynecology 2018; 8, 1–9.

24. Temesgen MA. Magnitude of Postpartum Hemorrhage among Women Delivered at Dessie Referral Hospital, South Woll, Amhara Region, Ethiopia. J Women's Health Care 2017; 6: 391.

25. Gudeta TA, Kebede DS, Nigeria GA, Dow MK, Hassen S. Magnitude of Post-Partum Hemorrhage among Women Who Received Postpartum Care at Bedele Hospital South West, Ethiopia, 2018. J Preg Child Health 5: 396.

26. Gani N, Ali TS. Prevalence and factors associated with maternal postpartum hemorrhage in Khyber Agency, Pakistan. J Ayub Med Coll Abbottabad 2013; 25(1–2): 81–5. 25098062

27. Mousa HA, Blum J, Abou El Senoun G, Shakur H, Alfirevic Z. Treatment for primary postpartum haemorrhage. Cochrane Database Syst Rev 2014; 12:CD003249.

28. Milman N. Postpartum anemia I: definition, prevalence, causes, and consequences. Ann Hematol 2011; 90:1247–53. doi: 10.1007/s00277-011-1279-z 21710167

29. Dunning T, Harris JM, Sandall J, Francis R, Magee H, Askham H, et al. Women and their birth partners’ experiences following a primary postpartum haemorrhage: a qualitative study. BMC Pregnancy Childbirth 2016; 16:80. doi: 10.1186/s12884-016-0870-7 27089951

30. Central Statistical Agency (CSA) [Ethiopia] and ICF. Ethiopia Demographic and Health Survey 2016. Addis Ababa, Ethiopia 2017. Available:

31. Legesse T, Abdulahi M, Dira A. Trends and causes of maternal mortality in Jimma University specialized Hospital, Southwest Ethiopia: a matched case–control study. International Journal of Women’s Health 2017:9 307–313. doi: 10.2147/IJWH.S123455 28496370

32. Teka H, Zelelow YB,. A 3 Years Review of Maternal Death and Associated Factors at Ayder Comprehensive Specialized Hospital, Northern Ethiopia. Ethiopian Journal of Reproductive Health 2018; 10; 3: 38–45.

33. Mekonnen W, Hailemariam D, Gebremariam A. Causes of maternal death in Ethiopia between 1990 and 2016: systematic review with meta-analysis. Ethiop. J. Health Dev. 2018; 32(4):225–242.

34. Sara J, Haji Y, Gebretsadik A. Determinants of Maternal Death in a Pastoralist Area of Borena Zone, Oromia Region, Ethiopia: Unmatched Case-Control Study. Obstetrics and Gynecology International Volume 2019, Article ID 5698436, 9 pages

35. Rajput N, Paldiya D, Verma YS. Effects of advanced maternal age on pregnancy outcome. Int J Reprod Contracept Obstet Gynecol. 2018; 7(10):3941–3945.

36. Blomberg M, Birch Tyrberg R, Kjølhede P. Impact of maternal age on obstetric and neonatal outcome with emphasis on Primiparous adolescents and older women: a Swedish Medical Birth Register Study. BMJ Open 2014; 4:e005840. doi: 10.1136/bmjopen-2014-005840 25387756

37. Laxmy R, Beena G. Pregnancy outcome in women of advanced maternal age. Int J Bioassays. 2013; 2(9):1193–8.

Článek vyšel v časopise


2019 Číslo 10