38

POSTPARTUM HAEMORRHAGE, (R.C.O.G. TABLE 25)

DR. GEORGE HENRY

Summary: f" B o o k e d = 1 5 2

(a) To t a l n u m b e r of cases . . . . . . . . . . . . 1 6 4 ~ U n b ° ° k e d ~ 12

P r i m i p a r a = 41 Mul t ipa ra -~ 123

Inc idence aga ins t t o t a l deliveries 28 weeks m a t u r i t y and over (5,273) . . . . . . . . . 3.1 pe r cent .

f C a s e No. 75677 (b) Ma te rna l mor t a l i t y . . . . . . . . . . . . 1 ~ A c u t e f a t t y l iver

[ o f p r e g n a n c y Inc idence . . . . . . . . . . . . . . . . . . 0.6 per cent .

F i n some ins tances | c o n d i t i o n s o the r

(v) N u m b e r of pa t i en t s t r a n s f u s e d w i t h blood ... 68-~ t h a n P . P . H . ] i n f l u e n c e d t he [ t r a n s f u s i o n

(d) N u m b e r of cases in wh ich shock developed ... 13

TYPES OF HAEMORRHAGE AND ESTIMATED CAUSE:

Primary (93) (a) Atonic . . . . . . . . . . . . . . . . . . . . . 47 (b) A d h e r e n t p l a c e n t a . . . . . . . . . . . . . . . 20 (c) T r a u m a t i c . . . . . . . . . . . . . . . . . . 17 (d) Clot t ing defec t . . . . . . . . . 4 (e) Re ta ined p r o d u c t s of c o n c e p ~ o n . . . . . . . . . 5

Secondary (69)

(a) Re ta ined p r o d u c t s of concep t ion . . . . . . . . . 62 (b) Aton ic . . . . . . . . . . . . . . . . . . . . . 2 (c) T r a u m a t i c . . . . . . . . . . . . . . . . . . 1 (d) U n k n o w n . . . . . . . . . . . . . . . . . . 4

Combined Primary and Secondary (2) (a) A d h e r e n t p l a c e n t a ... • . . 2

COMMENT

An active policy with regard to the management of the 3rd stage of labour is now the routine in the Hospital. This consists of intramuscular synto- metrine with delivery of the foetal head and controlled cord traction after the uterus has become firmly contracted. Intravenous ergometrine is reserved for instrumental deliveries performed under general anaesthesia and anaemic patients.

It is noteworthy that 68 of the 164 patients, or almost 42 per cent., who sffffered a postpartum haemorrhage, received a blood transfusion. This is almost the same incidence as the previous year. The desirability of this high incidence of replacement transfusion must be questioned in view of the attendant risks and ever increasing demand for blood.

The incidence of secondary postpartum haemorrhage remains at art alarmingly high level. It is an impression that the increased availability of blood in recent years has dimmed the obstetrician's attention to detail in the management of the 3rd stage.