Risk factors for composite adverse outcomes of postpartum haemorrhage in a low-resource setting: a single-centre cross-sectional study in Mpilo Central Hospital, Bulawayo, Zimbabwe

Abstract

Background: Primary postpartum haemorrhage continues to cause considerable global maternal morbidity and mortality. The aim of this study was to determine the risk factors for composite adverse outcomes in postpartum haemorrhage using multivariable logistic regression. The findings could potentially be used to anticipate and prevent composite adverse outcomes in postpartum haemorrhage. Methods: This was a retrospective cross-sectional study carried out at Mpilo Central Hospital, a government tertiary referral centre, covering the period 1 July 2016 to 30 November 2019. Participants were included in the study if they had a diagnosis of postpartum haemorrhage. Those variables that had a p<0.2 from the univariate logistic regression analyses were considered for multivariable logistic regression. The association between independent variables and the dependent variable was assessed using odds ratio with 95% confidence intervals, to identify independent risk factors for composite adverse outcomes in PPH. Results: The independent risk factors for composite adverse outcomes in postpartum haemorrhage were place of dwelling (AOR 4.57, 95% CI 1.87-11.12, p=0.01), prior history of a Caesarean section (AOR 2.57, 95% CI 1.10-6.00, p=0.03), APH (AOR 5.45, 95% CI 2.23-13.27, p<0.0001), antenatal haemoglobin level (AOR 19.64, 95% CI 1.44-268.50, p=0.03), and delivery by Caesarean section (AOR 10.21, 95% CI 4.39-23.74, p<0.0001). Blood loss was also an independent risk factor for composite adverse outcomes in postpartum haemorrhage with the following blood loss; 1001-1500 ml (AOR 9.94, 95% CI 3.68-26.88, p<0.0001), 500-1000 ml (AOR 41.27, 95% CI 11.32-150.54, p<0.0001), and 2001 ml (AOR 164.77, 95% CI 31.06-874.25, p<0.0001). Conclusions: This study found that the independent predictors for composite adverse outcomes in PPH were rural dwelling, prior history of a Caesarean section, antenatal haemoglobin level, delivery by Caesarean section, and blood. In low- and middle-income countries, such information should help in increasing clinical vigilance and preventing maternal deaths.