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Abstract
Introduction: Postpartum haemorrhage (PPH) is a common cause of maternal death worldwide, but data on PPH incidence and the possible causes are scarce. Erythrocyte suspension transfusion before birth, placenta Previa, birth canal avulsion, administration of general anaesthesia before delivery, and maternal anemia are major factors influencing PPH in nulliparous and multiparous women. It has been noticed that a vast majority of these incidences are reported amongst hypertensive patients who have been prescribed Calcium Channel blockers like Amlodipine and diltiazem. Calcium channel blockers work by inhibiting the uptake of Calcium ions by cardiac and smooth muscle cells and thus lead to vasodilation and decreased contractility of cardiac muscles. It has been noted that uterine involution, i.e. a process of endometrial contraction after birth, is essential to prevent PPH in women after delivery. These contractions rely heavily on the influx of Calcium ions into the smooth muscle cytosol, and by inhibiting this influx of Calcium ions, Calcium channel blockers may lead to an atonic uterus. A study claims that 12.6% of women with pre-existing or gestational hypertension were prescribed CCBs, and 2.7% of them experienced PPH.
Objectives: The objectives of this study were to determine the incidence of postpartum hemorrhage among users of calcium channel blockers, to assess the level of public awareness regarding postpartum hemorrhage, and to identify the most commonly used calcium channel blockers in current medical practice.
Materials and Methods: This cross-sectional study was conducted at Holy Family Hospital and included all women admitted with postpartum hemorrhage who had been prescribed calcium channel blockers prior to admission. A total sample of 310 patients was calculated using the WHO sample size calculator with a 95% confidence interval and a 5% margin of error. Participants were selected through random sampling, and only those who provided informed consent and had a history of CCB use were included, while patients unwilling to participate were excluded. Data were collected using a self-administered English-language questionnaire that gathered demographic information and explored the relationship between CCB use and postpartum hemorrhage. After explaining the study objectives and obtaining written consent, printed questionnaires were distributed to eligible patients over a four-week period. Data were analyzed using descriptive and inferential statistical methods, with Microsoft Excel and SPSS version 27 employed to ensure accuracy.
Results: It has been noted that almost 34% of the Pakistani women suffer from post partum haemorrhage. PPH has also been accounted for 27.1% of maternal deaths with 90% of those deaths occurring within 24 hours of delivery. Amongst the causes of PPH, atonicity of the uterus is the most significant and is related to the use of Calcium channel blockers in almost 3.2 percent of cases.
Conclusions: Postpartum haemorrhage (PPH) is an obstetric emergency complicating 1–10% of all deliveries and is a leading cause of maternal mortality and morbidity worldwide. Similarly, in Pakistan alone, the use of CCBs is seen in 13 percent of the Pakistani population. 46.2% of the Pakistani population suffers from hypertension, with the majority of patients, i.e., 16.6% being women. The knowledge of postpartum haemorrhage in Pakistan is extremely scarce. Similarly, research is being conducted presently to improve our knowledge regarding the interrelationship between the use of CCBs and PPH.
Keywords: Postpartum haemorrhage, Calcium channel blockers, Hypertension, Atrophy of the Uterus