Postpartum hemorrhage in Sub-Saharan Africa-a prospective study in metropolitan Mozambique

Michael M Glenzer; Momade Correia; Virgilio Nhantumbo; Richard Fw Barnes; Elvira Luis; Ines Boaventura; Nelia Manguele; Patricia Silva; Annette von Drygalski

doi:10.1016/j.jtha.2023.09.002

Postpartum hemorrhage in Sub-Saharan Africa-a prospective study in metropolitan Mozambique

J Thromb Haemost. 2023 Dec;21(12):3463-3476. doi: 10.1016/j.jtha.2023.09.002. Epub 2023 Sep 13.

Authors

Michael M Glenzer¹, Momade Correia², Virgilio Nhantumbo³, Richard Fw Barnes⁴, Elvira Luis², Ines Boaventura², Nelia Manguele³, Patricia Silva³, Annette von Drygalski⁴

Affiliations

¹ Department of Medicine, University of California San Diego, San Diego, California, USA. Electronic address: mglenzer@health.ucsd.edu.
² Department of Gynecology/Obstetrics, Universidade Eduardo Mondlane, Hospital, Central Maputo, Maputo, Mozambique.
³ Department of Hematology, Universidade Eduardo Mondlane, Hospital, Central Maputo, Maputo, Mozambique.
⁴ Department of Medicine, University of California San Diego, San Diego, California, USA.

PMID: 37709148
DOI: 10.1016/j.jtha.2023.09.002

Abstract

Background: Estimates indicate approximately ≈500 to 1000 maternal deaths per 100,000 live births in Sub-Saharan Africa (SSA) (vs ≈5-20 in developed countries). Postpartum hemorrhage (PPH) seems a major contributor to maternal mortality (MM), but there are no comprehensive data for the region.

Objectives: Analyze MM, PPH, and associated risk factors.

Methods: We collected prospective data on MM, PPH, and associated risk factors in metropolitan Mozambique. We recorded consecutive deliveries at the Maputo Central Hospital between February 2019 and January 2021. Data included age, HIV status, parity, delivery mode, notes, vital signs, laboratory values, and fetal parameters. PPH was determined by charted diagnosis, blood loss of >500 mL, transfusion, and/or notes indicating significant bleeding.

Results: Of 8799 deliveries, ≈40% occurred in women residing outside Maputo City ("nonlocal"), with similar demographic characteristics between local and nonlocal women. However, compared with local women, nonlocal women had worse outcomes, including higher rates of MM (1.52% vs 0.78%; P =.0012) and PPH (16.51% vs 12.39%; P <.0001), whereby PPH was strongly associated with MM (adjusted odds ratio = 5.56; P <.0001). Almost all women with uterine atony (≈1%) experienced PPH. For women receiving laboratory tests on admission (drawn only if in distress; local, n = 561; nonlocal, n = 514), both cohorts revealed similar distributions of hemoglobin levels and platelet counts. Prepartum anemia (≈57%) and thrombocytopenia (≈21%) were prominent risk factors for PPH; risk increased with increasing severity and was additive in the presence of both.

Conclusions: PPH is a serious problem in Maputo province, a metropolitan area of SSA, portending high MM. Identification of correctable risk factors, including anemia, should catalyze the development of region-specific prevention protocols.

Keywords: Mozambique; Sub-Saharan Africa; anemia; maternal mortality; postpartum hemorrhage; risk factor.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Anemia* / diagnosis
Anemia* / epidemiology
Female
Humans
Maternal Mortality
Mozambique / epidemiology
Postpartum Hemorrhage* / diagnosis
Postpartum Hemorrhage* / epidemiology
Postpartum Hemorrhage* / etiology
Pregnancy
Prospective Studies
Risk Factors