Background: Anemia in any phase of pregnancy is associated with much morbidity and risk of mortality to the mother and the fetus, it is a global health concern and is quite prevalent in Africa. About 58% of pregnant women in Nigeria are said to be anemic and earlier reports from this study site showed that 69.6% of women initiating antenatal care were anemic, it was commoner in women of teen-age and the hematocrit was lower as the gestational age at booking increased.
Methods: We assessed 464 consenting consecutive pregnant women who presented to our labour ward between November 2017 and July 2018 to know their age, booking status, haematocrit at late pregnancy and followed on to know the mode of delivery as well as the occurrence of postpartum bleeding. The data were analysed using IBM Statistical Package for Social Sciences version 23.
Results: A total of 462 consenting women were included in the study, majority of study participants were between the age of 26-35 years 299 (64.7%) with a minimum age of 15 years and maximum age of 47 years and mean age was 31.2 ± 5.2 years. The majority had moderate to severe anemia 335 (70.3%) and were booked for antenatal care with trained personnel 402 (87.2%) and 47 (10.2%) of them developed post-partum haemorrhage.
A significantly higher proportion of the study participants who were un-booked presented with severe anemia (χ2 =14.3; p=0.001); developed PPH (χ2 =13.9; p<0.001) Table 1. The highest proportion of persons who developed postpartum hemorrhage was found in persons with severe anaemia. This difference was significant. (χ2 =87.1; p<0.001).
Hematocrit was found to be the strongest determinant of the occurrence of postpartum hemorrhage among the study participants. The adjusted regression analysis showed that for every one-unit increase in hematocrit of study participants, there was a 16% reduction in the probability of occurrence of PPH and this probability was statistically significant (p<0.001). Booking status was also found to be a predictor of PPH such that un-booked women were 2.3 times more likely to experience PPH than booked women in the study population. This was found to be significant (p=0.04). Table 2
This data supports earlier findings that anaemia worsens the outcome of pregnancy. Unbooked mothers are more at risk of dire outcomes such as postpartum haemorrhage which is the leading cause of maternal mortality. There is a need for guidelines and enforcement of such at all levels of healthcare delivery especially in unorthodox centres where women go for care, as is common in developing countries. The need for health education and active prevention and management of anaemia in the early stages of pregnancy is advocated.
No relevant conflicts of interest to declare.
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