Prevalence, emerging aetiologies, and contemporary predictors of primary postpartum haemorrhage in a tertiary-level obstetric population in Nnewi, Nigeria: a pilot study.
George Uchenna Eleje, Joseph Ifeanyichukwu Ikechebelu, Chiamaka Perpetua Chidozie, Divinefavour Echezona Malachy, Emmanuel Chukwubuikem Egwuatu, Isaiah Chukwuebuka Umeoranefo, Timothy Abiola Oluwasola, Usman Bolarinwa Raji, Gbenga Olorunfemi, Lydia Ijeoma Eleje, Kingsley Chukwuebuka Agu, Chukwunonso Isaiah Enechukwu, Safiya Usman Zahradeen, Aisha Shehu Shanono, Nnabuike Okechukwu Ojiegbe
Abstract
Open AccessBackground: Primary postpartum haemorrhage (PPPH) is a leading cause of maternal morbidity and mortality in low-resource settings, with evolving aetiological patterns and contextual risk factors. However, current data from Nigerian obstetric populations are limited. Objectives: This study evaluated the current prevalence, causes and predictors of PPPH among parturients in Nnewi, southeastern Nigeria. Methods: This pilot analytical cross-sectional study was conducted at Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria, from 1 April to 30 September 2025. Postpartum women were consecutively recruited and provided data through structured KoboToolbox-assisted questionnaires and medical record review. The primary outcome was PPPH prevalence, defined as blood loss ≥500 mL following vaginal birth or ≥1000 mL following caesarean delivery within 24 hours. Secondary outcomes assessed aetiologies and associated factors. Binary logistic regression identified predictors, reported as adjusted odds ratios (aORs) with 95% confidence intervals (CIs), with significance set at p < 0.05. Results: Among 352 participants, 8.8% (95% CI: 6.0-12.5%; n = 31) experienced PPPH. The overall median estimated blood loss was 320 (55-2150) mL. Genital tract trauma (58.1%; 95% CI: 34.4-91.8%) was the leading cause, followed by uterine atony (32.3%; 95%CI: 15.5-59.3%). Increasing parity (aOR=1.46; 95% CI: 1.0-2.1; p= 0.03) and antepartum haemorrhage (aOR =5.39; 95% CI: 1.3-21.9; p=0.02) were significant predictors of PPPH. Conclusion: This pilot study demonstrates a shift from uterine atony to genital tract trauma as the predominant cause of PPPH in this setting. Increasing parity and antecedent antepartum haemorrhage were independent predictors. This reinforces the importance of enhanced intrapartum monitoring, trauma-focused prevention strategies and skilled obstetric care.