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Abstract

Background: Primary postpartum hemorrhage (PPH) is a major cause of maternal morbidity and mortality worldwide.
Objective: To determine the frequency of primary postpartum hemorrhage due to cervical and perineal tears during vaginal delivery and to assess associated maternal and obstetric risk factors.
Methodology: This cross-sectional study was conducted at Unit II, Department of Gynecology and Obstetrics, Ghulam Muhammad Mahar Medical College (GMMMC), Sukkur, from April 2205 to July 2025. A total of 200 women aged 18–40 years, with gestational age >32 weeks and parity <5, were enrolled using non-probability consecutive sampling. Women with multiple gestations, abnormal placentation, or a history of PPH were excluded. Demographic, obstetric, and clinical data were collected using a structured proforma. Participants were followed for 24 hours post-delivery, and blood loss >500 mL after vaginal delivery was labeled as PPH.
Results: The mean age of participants was 28.6 ± 5.1 years, and the mean gestational age was 37.8 ± 1.6 weeks. Perineal tears were found in 59% of cases, while cervical tears occurred in 41%. Primary PPH developed in 27 women (13.5%), with 66.7% attributed to cervical tears and 33.3% to perineal tears. PPH was significantly associated with anemia (p = 0.021), instrumental delivery (p = 0.015), and cervical tears (p = 0.008). No significant correlation was found with age, BMI, or parity.
Conclusion: It is concluded that trauma, particularly cervical tears, is a considerable cause of primary postpartum hemorrhage following vaginal delivery. Careful postpartum genital examination, early detection and repair of tears, correction of antenatal anemia, and skilled obstetric practices are essential to prevent trauma-related hemorrhage and improve maternal safety.