Postpartum Hemorrhage and Maternal Deaths in North East India

Hemorrhage, usually occur in the postpartum period, is responsible between one quarter and one third of obstetric deaths. According to the world health organization, obstetrics hemorrhage causes 127,000 deaths annually worldwide and is the leading cause of maternal mortality. Postpartum hemorrhage (PPH) is a frequent complication of delivery and its incidence is commonly reported as 2% 4% after vaginal delivery and 6% after cesarean section with uterine atony being the cause in about 50% cases. The risk of dying from PPH depends not only on the amount and the rate of blood loss but also the health status of the woman. PPH remains the number one killer of mothers and accounts about 28% of all maternal deaths in developing countries. There is an increase risk in the PPH even in developed countries due to number of changes in recent years. In India, Maternal mortality rate (MMR) is 212 but in the state of Manipur (Regional Institute of Medical Sciences, RIMS), situated in the far corner of North East MMR is 91.68 (94 maternal deaths/102525 live births during year 2000-2010). Out of 94 deaths, 53.19% died due to hemorrhage and PPH accounts about 21.27% of total deaths. Again, almost all these PPH died within the first 24 hours of admission. High parity and home delivery brought late due to varied reasons with preexisting anemia are the common problems on analysis of maternal deaths due to PPH in our set up. Whatever the cause, death should be preventable and outcome is largely dependent upon timely interference and efficiency and vigor of medical practitioners. A pregnant woman and her family must understand the risks involved in each pregnancy. Even with different interventions and blood transfusion facility, maternal deaths cannot be brought down to zero. But the best available health care facilities should be made available to all.