Prevalence Of Maternal Hypocalcemia and Its Association with Atonic Postpartum Hemorrhage Among Parturients Delivering at Bugando and Sekou Toure Hospitals, Mwanza, Tanzania.
- Mwanza, Tanzania | Catholic University of Health and Allied Sciences [CUHAS-Bugando] | 2024.
- 89 Pages Includes References
Abstract:
Background: Globally, postpartum haemorrhage contributes to about 70,000 maternal deaths annually. Its prevalence has been estimated to be around 10.8% globally, 25.7% in Africa and 11.9% in Tanzania. Contemporary studies revealed marked variation in prevalence of hypocalcemia, ranging from 23% to 70%. Hypocalcemia causes weakness in myometrial contractility and postulated among the risk factor for atonic postpartum hemorrhage. This study was focused on determination of magnitudes of hypocalcemia and postpartum hemorrhage; predictors of maternal hypocalcemia and association between hypocalcemia and atonic postpartum hemorrhage among parturients delivering at BMC and Sekou Toure Hospitals, Mwanza, Tanzania, from August 2023 to May 2024.
Methodology: A cross-sectional study was applied in the determination prevalence of maternal hypocalcemia a atonic PPH as well factors associated with maternal hypocalcemia. A matched case control study had its role in the determination of association between hypocalcemia and atonic postpartum hemorrhage. Data collection was accomplished by using a standardized, pretested and coded questionnaire. Collected data were entered into Microsoft Excel 2023 and subsequently analyzed using STATA version 15. To determine factors associated with maternal hypocalcemia, we applied bivariable logistic regression analysis and all factors with p-value <0.25 were subsequently subjected to multivariable logistic regression analysis. To determine an association between hypocalcemia and atonic PPH, conditional logistic regression was used. In all analyses, the measure of strength of association was odd ratio (OR) that was determined with its respective 95% confidence interval (95%CI) and the significance of association was established at a statistical level of a p-value less than 0.05.
Results: The study enrolled 1049 pregnant women with predominant group aged between 20 to 34 years (78.8%) with median age of 27 years (IQR = 23-32). The prevalence of maternal hypocalcemia and primary atonic postpartum hemorrhage were 23.6% and 7.6% respectively. Factors associated with maternal hypocalcemia were pruritus (aOR 3.6; 95% CI [2.0-6.3]; pvalue <0.001), paraesthesia (aOR 3.3; 95% CI [1.7-6.4]; p-value <0.001) and muscle cramps (aOR 5.0; 95% CI [1.1-23.4]; p-value 0.043). Maternal hypocalcemia was associated with atonic postpartum hemorrhage (aOR 13.8; 95% CI [5.8-33.3]; p-value ˂ 0.001).
Conclusion and recommendations: This study found that, for every 5 and 13 parturients one had hypocalcemia and atonic PPH, respectively. Factors associated with maternal hypocalcemia were pruritus, paraesthesia and muscle cramps. There was an association between maternal hypocalcemia and atonic PPH. Health education should be imparted to the community, aiming at creating awareness on consumption of calcium rich diets. Calcium supplementation should be given to all pregnant women as well as during preconception care. Pregnant women with clinical manifestations of hypocalcemia as well as those with high risk for atonic postpartum hemorrhage should be screened for hypocalcemia. There is a need to conduct a randomized clinical trial to investigate whether pre-delivery correction of hypocalcemia will reduce the incidence of atonic postpartum hemorrhage.
Wurzburg Road 35, Premises, Post Code: 33102 | P. O. Box 1464 Mwanza, Tanzania | Phone: (255) 28-298-3384 | Fax: (255) 28-298-3386 | Email: vc@bugando.ac.tz | Website: www.bugando.ac.tz