OC 52.3 - Post-Partum Hemorrhage in Sub-Saharan Africa – First Results from a Prospective Study in Mozambique

Tuesday, July 12, 2022

11:15 AM – 11:30 AM

Location: ExCel Center, S11B

Presentation Format: In-Person

Co-Author(s)

MG

Michael Glenzer, MPH

Statistician
University of California San Diego
San Diego, California, United States
RB

Richard FW Barnes

Statistician
University of California San Diego, Dept of Medicine, San Diego, USA
San Diego, California, United States
MC

Momade Correia

Gynecologist
Universidade Eduardo Mondlane
Maputo, Maputo, Mozambique
EL

Elvira Luis

Gynecologist
Universidade Eduardo Mondlane
Maputo, Maputo, Mozambique
IB

Ines Boaventura

Gynecologist
Universidade Eduardo Mondlane, Depts of Gynecology/Obstetrics and Hematology
Maputo, Maputo, Mozambique
VN

Virgilio Nhantumbo

Hematologist
Universidade Eduardo Mondlane
Maputo, Maputo, Mozambique
NM

Nelia Manguele

Hematologist
Universidade Eduardo Mondlane, Depts of Gynecology/Obstetrics and Hematology
Maputo, Maputo, Mozambique
PS

Patricia Silva

Hematologist
Universidade Eduardo Mondlane
Maputo, Maputo, Mozambique

Presenting Author(s)

Annette von Drygalski, MD

Director, Hemophilia & Thrombosis Treatment Center
University of California San Diego
La Jolla, California, United States

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.