1. TEMPLATE DESIGN © 2008 www.PosterPresentations.com The Impact of Postpartum Haemorrhage (PPH) on Maternal Morbidity A Mackeen, SY Khong Department of Obstetrics and Gynaecology, University Malaya Medical Centre (UMMC), Malaysia ABSTRACT RESULTS CONCLUSION REFERENCE Green Top Guideline no52 –RCOG. Fuchs KM, Miller RS, Berkowitz RL. Optimizing outcomes through protocols, multidisciplinary drills, and simulation. Semin Perinatol. 2009 Apr;33(2):104-8. Report on the Confidential Enquiries into Maternal Deaths in Malaysia 2001-2005, Published 2008. Jyothshna Bayya, Ahmed Ahmed, Sandra McCalla, Howard Minkoff, Maimonides Medical Center, Brooklyn, NY Multidisciplinary simulated postpartum hemorrhage drills in labor & delivery. Supplement to Jan 2011 American Journal of Obstetrics & Gynecology. Reviewing Maternal deaths to make motherhood safer-Eighth Report of Confidential Enquiries into Maternal Deaths In United Kingdom for year 2006-2008.Published on March 2011. Postpartum Haemorrhage: A Continuing Tragedy in Malaysia K Siva Achanna, FRCOG Professor of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences-Tingkat 13, Menara B, Persiaran MPAJ, Jalan Pandan Utama, Pandan Indah, 55100 Kuala Lumpur, Malaysia RESULTS RISK FACTORS OF PPH 47.7% had BMI of 26 to 30 kg/m2. OPTIONAL LOGO HERE STUDY DESIGN PPH remains one of the most common causes of maternal mortality worldwide. Delay in diagnosis and suboptimal management are often significant contributing factors leading to maternal morbidity and mortality. OBJECTIVES METHOD To investigate the incidence and management of PPH and to identify its risk factors in UMMC. Women who delivered between September and November 2011, and had vaginal blood loss more than 500ml at vaginal delivery and more than 1000ml in caesarean delivery within 24hours of delivery, were identified. Data collected included ethnicity, age, parity, BMI, medical history, haemoglobin level, ultrasonographic findings, details of previous and current delivery such as induction, duration of labour, mode of delivery and estimated blood loss. Types of medical and/or surgical management and the timing of intervention were evaluated. 4.5% had previous history of PPH. 25% had >=1 previous Caesarean section. 36.4% 6.8% 31.8% 25% 45.5% were managed by medical means only while 54.5% also needed surgical intervention. Oxytocin was the most commonly used drug for PPH (79.5%). Cause of PPH The incidence of PPH in UMMC is 3%. There was no maternal mortality secondary to PPH. Maternal morbidity includes - Blood transfusion was required in 31.8%. - 54.5% needed surgical intervention. Generally, documentation of the management of PPH was poor. To optimize our clinical practice, we suggest – Increased awareness of the guideline. Running obstetric ‘drills’. Using a proforma for documentation. 52.3% were aged 20 to 30years. PPH among various ethnicity in Malaysia. Mode of delivery Hb% (gm/dl ) on admission. There were 6.8% multiple pregnancies. 31.8% had amniotic fluid index (AFI) >18cm. Placental praevia existed in 13.6%. Placental tissue was retained in 6.8%. Retrospective observational study. Estimated blood loss Blood transfusion was required in 31.8%. OUTCOME OF DELIVERY 31.8 % had undergone induction of labour. 18.2% were in labour for more than 8 hours. 500ml - 999ml 1000ml - 2000ml >2000ml OTHER- ASIAN MALAY CHINESE NON-ASIAN INDIAN Ethnicity Hb (gm/dl) Mode of delivery Causes of PPH % 4.5% 20.5% 9.1% 65.9% 0% % %