Incidence, treatment and outcomes of postpartum haemorrhage among women admitted at a large regional referral hospital in eastern Uganda: a one-year prospective observational study

F Bulamba; T Stephens; A Hewitt-Smith; T E F Abbott; A Patel; K Mugabe; M W Musaba; J Nakibuule; J Khanyalano; H A Maiga; L Nandyose; M Kabaleta; W Weere; C Mugume; J Nanimambi; M Sejja; Rupert M Pearse

doi:10.1016/j.ijoa.2025.104707

Incidence, treatment and outcomes of postpartum haemorrhage among women admitted at a large regional referral hospital in eastern Uganda: a one-year prospective observational study

Int J Obstet Anesth. 2025 Jun 19:64:104707. doi: 10.1016/j.ijoa.2025.104707. Online ahead of print.

Authors

F Bulamba¹, T Stephens², A Hewitt-Smith³, T E F Abbott², A Patel², K Mugabe⁴, M W Musaba⁵, J Nakibuule⁶, J Khanyalano⁶, H A Maiga⁷, L Nandyose⁶, M Kabaleta⁶, W Weere⁶, C Mugume⁶, J Nanimambi⁶, M Sejja⁶, Rupert M Pearse²

Affiliations

¹ William Harvey Research Institute, Queen Mary University of London, London, United Kingdom; Department of Anesthesia and Critical Care, Faculty of Health Sciences, Busitema University, Mbale, Uganda; ELCHRI Elgon Center for Health Research and Innovation, Mbale, Uganda. Electronic address: f.bulamba@qmul.ac.uk.
² William Harvey Research Institute, Queen Mary University of London, London, United Kingdom.
³ William Harvey Research Institute, Queen Mary University of London, London, United Kingdom; Department of Anesthesia and Critical Care, Faculty of Health Sciences, Busitema University, Mbale, Uganda; ELCHRI Elgon Center for Health Research and Innovation, Mbale, Uganda.
⁴ Department of Obstetrics and Gynaecology, Mbale Regional Referral Hospital, Mbale, Uganda.
⁵ ELCHRI Elgon Center for Health Research and Innovation, Mbale, Uganda; Centre of Excellence for Maternal Reproductive and Child Health, Busitema University, Mbale, Uganda.
⁶ ELCHRI Elgon Center for Health Research and Innovation, Mbale, Uganda.
⁷ ELCHRI Elgon Center for Health Research and Innovation, Mbale, Uganda; School of Nursing and Midwifery, Islamic University in Uganda, Mbale, Uganda.

PMID: 40644830
DOI: 10.1016/j.ijoa.2025.104707

Abstract

Background: Postpartum haemorrhage (PPH) is the leading cause of maternal mortality in Africa. We studied the incidence, treatment and outcomes of PPH in a large referral hospital in eastern Uganda.

Methods: This was a prospective observational study including women admitted to a referral hospital for obstetric care, with in-hospital PPH as the primary outcome and in-hospital mortality as secondary outcome. Data were collected through direct observation on 166 randomly selected days. Multivariable analysis using logistic regression was conducted to determine risk factors for PPH.

Results: We recruited 22.0% (2,358/10,842) of all women delivering at the hospital from February 2021 to March 2022; PPH rate was 7.1% (167/2,358) and was associated with greater maternal mortality (4/167 (2.4%) with PPH vs. 2/2,191 (0.1%) without PPH; OR 26.9 [4.9-147.9]; P <0.0001). In multivariable analysis, preeclampsia (OR 2.25 [1.1-4.6]; P = 0.027) and twin pregnancy (OR 3.2 [1.7-6.2]; P <0.001) were associated with increased risk of PPH while caesarean delivery (OR 0.5 [0.3-09]; P = 0.009) and delivery between 4-10 pm (OR 0.6 [0.4-0.9]; P = 0.032) were associated with a reduced risk. There were 448 women (including 281 delivered elsewhere) treated for PPH; 3.3% were treated by an obstetrician at the bedside, 44.0% could have immediately received blood and 47.0% tranexamic acid if needed.

Conclusions: One in 14 women delivered at a large Ugandan hospital developed PPH. Rates of PPH and death are far higher than in high-income countries. Our findings highlight staffing shortages and supply chain failures that impact the management of PPH.

Keywords: Maternal mortality; Observational study; Postpartum haemorrhage; Risk factors.