Comparison of Frequency of Postpartum Hemorrhage in Spontaneous versus Prostaglandin Induced Labour at Term Gestation

Abstract

Objective: To compare the frequency of postpartum haemorrhage in spontaneous versus induced labor at
term.
Study Design: A comparative cross-sectional study.
Place and Duration of Study: The study was conducted at the Department of Obstetrics and Gynecology,
Benazir Bhutto Hospital Rawalpindi, Pakistan from April 2021 to March 2022.
Methods: A sample size of 108 women fulfilling inclusion criteria was categorized into two equal groups of 54;
Group-A spontaneous onset of labor (SOL) and Group-B of induced labor with prostaglandin (IOL). Both groups
were analysed for the frequency of postpartum haemorrhage PPH. Also, the association was checked by using
Pearson Chi-square test of significance and t-test for comparing means. A P-value of ≤ 0.05 was considered as
significant.
Results: The mean age of women in Group-A vs Group B was 26.78±4.78 years vs 25.96±4.70 years. Mean
gestational age was 38.33±0.97 weeks vs 38.72±1.02 weeks. Multigravida (67%) were more than primigravida
(33%). Postpartum haemorrhage was seen more in Group-B 24 (44.4%) compared with Group-A 11 (20.4%),
with a significant P-value (P = 0.008). The mean estimated blood loss (EBL) was higher in Group-B
(675.00±420.41 ml) than in Group-A (442.78±279.25 ml) with a significant P-value (P = 0.003). EBL in each group
was cross checked by Haematocrit levels (%Hct) and mean value of %Hct was decreased post- delivery in
women with postpartum hemorrhage. Consequently, blood transfusions were more in Group-B 16 (29.6%)
than Group-A 9 (16.7%). Upon stratification for parity, the rate of PPH was higher in multigravida. The secondary
maternal outcomes like; prolonged second stage of labour, uterine atony and retained placental tissues were
also more in Group-B.
Conclusion: The induction of labor is associated with a significant risk of postpartum hemorrhage and should be offered only when it is deemed necessary.