Comparison of Maternal and Neonatal Outcome Among In-Patients and Referred Cases with Postpartum Hemorrhage Visiting Liaqat Memorial Hospital Kohat

Abstract

Background: Postpartum hemorrhage (PPH) is the leading cause of maternal mortality globally, with particularly high rates in low-resource settings like Pakistan. Despite improvements in obstetric care, delayed referrals and systemic disparities continue to worsen outcomes, necessitating localized research into maternal and neonatal morbidity and mortality patterns. Objective: To compare maternal and neonatal outcomes among in-patients and referred cases with primary postpartum hemorrhage at Liaqat Memorial Hospital Kohat, and to evaluate the association of parity, socioeconomic status, and mode of delivery with maternal morbidity and mortality. Methods: This was a cross-sectional descriptive study involving 137 women with primary PPH managed between 2023 and 2024. Women were included if they experienced blood loss >500 ml within 24 hours postpartum; those with bleeding disorders, on anticoagulants, or refusing consent were excluded. Data were collected through structured interviews and hospital records, with outcomes including maternal anemia, acute renal failure, acute respiratory distress syndrome, and mortality. Ethical approval was obtained, and the study complied with the Declaration of Helsinki. Data analysis was performed using SPSS v20 with Chi-square tests, considering p-values <0.05 as significant. Results: Maternal morbidity occurred in 54.8% of cases, with anemia being the most common complication (40.1%). Cesarean delivery (p = 0.02), high parity (p = 0.03), and lower socioeconomic status (p = 0.01) were significantly associated with increased morbidity. Maternal mortality was recorded at 4.4%, significantly linked to high parity and poor socioeconomic background (p = 0.04). Conclusion: Primary postpartum hemorrhage remains a significant contributor to maternal morbidity and mortality, especially among multiparous women, cesarean deliveries, and socioeconomically disadvantaged populations. Targeted prenatal care, anemia prevention, cautious surgical decision-making, and strengthening referral systems are critical to improving maternal outcomes in similar healthcare settings.