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Table 2.1 CS rates by SDP 2011 and 2012
SDP 2011
2012 Total
women who
delivered Total CS
LSCS Rates
Total women
who delivered
Total CS LSCS
Rates
Elective Emergency NA
Elective Emergency NA
HTF, Perlis 4,087
193 741
22.85 3,920
223 691
23.32 HSB, Kedah
10,396 705
1,861 24.68
10,307 741
2,017 2
26.78 HPP
3,336 305
1,123 42.81
3,010 360
962 43.92
HRPB, Perak 6,217
644 2,175
1 45.36
4,507 687
2,099 61.81
HTAR,Selangor 12,351
704 2,128
1 22.94
12,056 699
2,362 1
25.40 HKL
11,729 711
2,594 28.18
11,843 765
3,035 1
32.09 HTJ,Negeri Sembilan
4,841 331
696 8
21.38 6,192
458 1,096
3 25.15
Hospital Melaka 10,833
686 1,698
22.01 10,746
746 1,791
23.61 HSA, Johor
12,467 636
2,601 25.96
12,295 679
2,617 26.81
HTAA, Pahang 9,333
550 1,656
3 23.67
8,728 477
1,505 22.71
HSNZ, Terengganu 12,019
572 1,646
2 18.47
12,803 596
1,411 11
15.76 HRPZ II, Kelantan
13,066 426
1,810 1
17.12 10,955
332 1,738
2 18.91
HU Sarawak 9,854
375 1,922
1 23.32
1,513 76
259 22.14
HL, Sabah 14,851
254 1,479
11.67 13,759
285 1,553
43 13.67
Total 135,380
7,092 24,130
17 23.08
122,634 7,124
23,136 63
24.73
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Graph 2.1 CS rates from SDP 2011 and 2012
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Table 2.2 Distribution of CS by ethnicity 2011 and 2012
Ethnicity 2011
2012 Total
women who
delivered Total CS
LSCS Total
women who
delivered Total CS
LSCS Elective
Emergency NA
Elective Emergency
NA n
n n
n n
n n
n
Malay 92,649
5,095 16,492
13 23.30
85,391 5,054
16,051 18
24.72 Chinese
8,428 688
1,616 27.34
7,417 722
1,471 3
29.57 Indian
6,400 513
1,705 4
34.66 6,128
524 1,740
1 36.95
KadazanDusun 4,003
100 454
13.84 3,685
111 500
13 16.58
Murut 345
15 57
20.87 262
6 29
4 13.36
Bajau 3,151
56 288
10.92 2,930
49 294
8 11.71
Melanau 123
2 16
14.63 38
4 7
28.95 Iban
2,149 78
391 21.82
760 24
121 19.08
Bidayuh 1,573
70 334
25.68 360
23 69
25.56 OA Peninsular Malaysia
909 36
242 30.58
748 59
218 37.03
Other indigenous group in Sabah Sarawak
2,695 52
307 13.32
2,338 54
284 4
14.46 Foreigners
11,333 328
2,025 20.76
10,593 423
2,007 10
22.94 Others
1,209 47
157 16.87
1,467 52
263 4
21.47 NA
413 12
46 13.98
517 19
82 19.96
Total 135,380
7,092 24,130
17 23.06
122,634 7,124
23,136 65
24.68
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Table 2.3: CS by Age and Parity 2011 and 2012
Age 2011
2012 Total
women who
delivered Total CS
LSCS Total
women who
delivered Total CS
LSCS Elective
Emergency NA
Elective Emergency
NA n
n n
n n
n n
n
10-14 127
2 10
9.45 126
4 13
13.49 15-19
6,731 70
797 12.88
5,736 68
693 3
13.32 20-24
26,048 631
4,070 3
18.06 22,513
545 3,549
9 18.23
25-29 46,963
1,896 8,494
9 22.14
43,421 1,910
8,397 25
23.79 30-34
33,305 2,420
6,175 2
25.81 30,830
2,521 6,097
19 28.01
35-39 17,052
1,587 3,416
3 29.36
15,404 1,625
3,280 8
31.89 40-44
4,765 446
1,073 31.88
4,262 420
1,027 1
33.97 45-49
362 39
89 35.36
314 29
72 32.17
50-54 26
1 6
26.92 26
2 6
30.77 55-59
1 0.00
2 2
100.00
Parity
1 46,158
1,388 10,564
6 25.91
42,679 1,387
10,325 27
27.51 2 - 5
81,166 5,316
12,315 8
21.73 73,336
5,372 11,709
34 23.34
≥ 6 7,840
378 1,235
3 20.61
6,537 363
1,094 4
22.35 NA
216 10
16 12.04
82 2
8 12.20
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Table 2.4 CS by risk level of booking 2011 and 2012 Risk Level at
Booking Caesarean
Total LSCS
Classical Hysterotomy
Hysterectomy Others
2011 n
n n
n n
n
Red 1129
3.64 7
5.38 3
17.65 4
7.55 0.00
1,143 3.65
Yellow 4946
15.94 13
10.00 3
17.65 7
13.21 2
25.00 4,971
15.88 Green
17103 55.12
80 61.54
3 17.65
28 52.83
5 62.50
17,219 55.01
White II 576
1.86 2
1.54 0.00
1 1.89
0.00 579
1.85 White I
3170 10.22
13 10.00
3 17.65
6 11.32
1 12.50
3,193 10.20
No Code 1149
3.70 5
3.85 2
11.76 2
3.77 0.00
1,158 3.70
NA 2956
9.53 10
7.69 3
17.65 5
9.43 0.00
3,041 9.71
2012
Red 1,185
3.93 5
3.79 2
9.09 6
11.76 0.00
1,198 3.94
Yellow 6,239
20.70 23
17.42 7
31.82 11
21.57 3
30.00 6,283
20.68 Green
17,077 56.66
71 53.79
13 59.09
30 58.82
7 70.00
17,198 56.61
White II 942
3.13 5
3.79 0.00
1 1.96
0.00 948
3.12 White I
2,705 8.98
16 12.12
0.00 0.00
0.00 2,721
8.96 No Code
1,031 3.42
3 2.27
0.00 3
5.88 0.00
1,037 3.41
NA 959
3.18 9
6.82 0.00
0.00 0.00
993 3.27
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Table 2.5 Distribution of medical problems and CS rates, 2011 and 2012 Medical Problems
Total delivery
Total CS 2011 CS
Rates Total
delivery Total CS 2012
CS Rates
Elective Emergency NA
Elective Emergency NA
Diabetes 11,899
1,220 3,074
2 13.41
10,974 1,168
2,879 2
13.01 Pre-existing
957 121
259 8.85
747 108
273 9.41
Gestational 10,880
1,091 2,799
2 90.60
9,460 999
2,434 2
84.84 NA
60 8
15 0.54
767 61
172 5.75
Missing 2
1 0.02
0.00
Hypertension 5,943
464 2,226
8.40 4,803
370 1,928
4 7.40
Pre-existing 1,060
114 350
17.25 805
84 321
1 17.64
Gestational 4,356
299 1,632
71.78 3,464
228 1,380
3 69.98
Pre-eclampsia 950
51 593
33.35 799
32 512
2 33.89
Eclampsia 49
1 38
2.02 57
1 46
2.92
Heart Disease 931
100 162
0.82 705
72 148
0.71 NYHA I
518 41
71 42.75
379 26
70 43.64
NYHA II 113
19 20
14.89 82
11 20
14.09 NYHA III
17 4
8 4.58
12 3
4 3.18
NYHA IV 1
1 0.38
4 2
0.91 Not Available
257 23
57 30.53
212 25
46 32.27
NA 25
12 9
8.02 16
7 6
5.91
Others 6,942
421 1,340
1 5.50
6,064 458
1,243 1
5.47 TB
77 7
13 1.14
73 6
14 1.18
Blood Disorder 1,079
63 184
14.02 987
58 172
13.51 CollagenDisease
5 2
0.11 2
0.00 Asthma
2,443 173
528 39.78
2,074 170
456 1
36.84 Renal Disease
37 4
9 0.74
46 8
14 1.29
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Table 2.6 CS in relation to accoucher 2011-2012 Accoucher
Caesarean 2011 Total
LSCS Classical
Hysterotomy Hysterectomy
Others n
n n
n n
n
Specialist 1,799
5.65 33
24.81 9
52.94 33
62.26 2
20.00 1,876
5.86 MO6 months OG
experience 28,619
89.95 97
72.93 8
47.06 19
35.85 8
80.00 28,751
89.77 MO6 months OG
experience 1,075
3.38 2
1.50 0.00
0.00 0.00
1,077 3.36
MO no OG experience 16
0.05 0.00
0.00 0.00
0.00 16
0.05 Other MO
45 0.14
0.00 0.00
0.00 0.00
45 0.14
Other MO HO 54
0.17 1
0.75 0.00
0.00 0.00
55 0.17
Caesarean 2012 Total
LSCS Classical
Hysterotomy Hysterectomy
Others n
n n
n n
n
Specialist 1,932
6.25 38
27.34 15.00
68.18 37
72.55 0.00
0.00 2,022
6.49 MO6 months OG
experience 27,948
90.36 92
66.19 7.00
31.82 13
25.49 10.00
100.00 28,070
90.11 MO6 months OG
experience 794
2.57 5
3.60 0.00
0.00 0.00
0.00 0.00
799 2.57
MO no OG experience 46
0.15 1
0.72 0.00
0.00 0.00
0.00 0.00
47 0.15
Other MO 12
0.04 0.00
0.00 1
1.96 0.00
0.00 13
0.04 Other MO HO
63 0.20
0.00 0.00
0.00 0.00
0.00 63
0.20
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Graph 2.2 Indications for CS 2011 and 2012
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Table 2.7 Apgar score in relation to CS 2011 and 2012 Caesarean 2011
Apgar at 1 min
CS Classical
Hysterotomy Hysterectomy
Others Total
n n
n n
n n
≤ 7 3,359
10.56 26
19.55 3
17.65 18
33.96 1
10.00 3,407
10.64 7
27,886 87.65
104 78.20
10 58.82
34 64.15
9 90.00
28,043 87.56
NA 571
1.79 3
2.26 4
23.53 1
1.89 0.00
579 1.81
Total 31,816
100 133
100 17
100 53
100 10
100 32,029
100
Apgar at 5 min
≤ 7 717
2.25 11
8.27 1
5.88 8
15.09 1
10.00 738
2.30 7
30,293 95.21
118 88.72
12 70.59
44 83.02
9 90.00
30,476 95.15
NA 806
2.53 4
3.01 4
23.53 1
1.89 0.00
815 2.54
Total 31,816
100 133
100 17
100 53
100 10
100 32,029
100
Apgar at 1 min
Caesarean 2012
≤ 7 2,946
9.53 18
12.95 11
50.00 23
45.10 1
10.00 2,999
9.63 7
27,817 89.94
117 84.17
8 36.36
22 43.14
9 90.00
27,973 89.80
NA 165
0.53 4
2.88 3
13.64 6
11.76 0.00
178 0.57
Total 30,928
100 139
100 22
100 51
100 10
100 31,150
100
Apgar at 5 min
≤ 7 646
2.09 5
3.60 7
31.82 7
13.73 0.00
665 2.13
7 30,081
97.26 130
93.53 11
50.00 37
72.55 10
100.00 30,269
97.17 NA
201 0.65
4 2.88
4 18.18
7 13.73
0.00 216
0.69 Total
30,928 100
139 100
22 100
51 100
10 100
31,150 100
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MASSIVE PRIMARY
POSTPARTUM HAEMORRHAGE
National Obstetrics Registry
National Obstetrics Registry
31
CHAPTER 3 MASSIVE PRIMARY POSTPARTUM HAEMORRHAGE SD Karalasingam¹, Ravindran J², R Jeganathan ³
1. National Clinical Research Centre 2. Kuala Lumpur Hopital
3. Sultanah Aminah Hospital, Johor
SUMMARY The standards set by MOH for Massive Primary PPH was achieved by all 14 hospitals
in 2011. In 2011 HSB Kedah had the highest incidence of Massive Primary PPH at 0.40 whilst in 2012 HTF Perlis had the highest rate of Massive Primary PPH at 0.54.
It was higher in women aged 40-
45 years and parity ≥6. Macrosomia, multiple pregnancy and prolonged labour contributed to Massive primary PPH.
3.1 INTRODUCTION KPI for Massive Primary PPH set by MOH, Malaysia is ≤ 0.5 of total deliveries. The
total number of deliveries for 2011 was 135,380 and 0.14 of deliveries were complicated by Massive Primary PPH from the 14 tertiary hospitals that provide data to
NOR. HL, Sabah had not reported any cases of Massive Primary PPH in 2011 but in 2012 there were 2 cases.The total number of deliveries for 2012 was 122,634 and 0.10
of deliveries were complicated by Massive Primary PPH from the SDP. The highest rate was seen from HTF Perlis at 0.54 followed by HKL and HSNZ Terengganu at
0.19. 3.2 PATIENT DERMOGRAPHICS
In 2011 Massive Primary PPH was highest among the Ibans at 0.23 followed by the Chinese at 0.21. Women aged 40-45 years had a high rate of Massive Primary PPH
at 0.52 a
nd parity ≥ 6 had a rate of 0.33.Similar findings were seen in 2012 where Massive Primary PPH was high in women aged 40-45 years at
0.35 and in parity ≥ 6 at 0.18 .
3.3 RISK FACTORS FOR MASSIVE PRIMARY PPH In both years risk factors for Massive Primary PPH were macrosomia, multiple
pregnancy and prolonged labour.
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3.4 CAUSES OF POSTPARTUM HAEMORRHAGE Uterine atony accounted for 24.74 of Massive Primary PPH in 2011 where else
uterine rupture accounted for 20.0 of Massive PPH in 2012 followed by uterine atony at 9.52.
3.5 MODE OF DELIVERY Massive Primary PPH was higher with CS as compared to vaginal and instrumental
delivery. In both years Classical CS contributed to the highest rate at 3.08 and 0.76 respectively.
3.6 CONCLUSION
The incidence of Massive Primary PPH from the SDP was 0.14 in 2011 and 0.10 in 2012 and this was higher than what was reported in the 2
nd
NOR report 2010. Women aged 40-44 yea
rs and Parity≥ 6 had the highest rate of Massive Primary PPH. Rates were higher following CS as compared to vaginal and instrumental deliveries and
Classical CS contributed to the highest rate in both years. 3.7 RECOMMENDATION
1. Regular audit and discussion of cases with Massive Primary PPH should be carried out at Departmental level.
2. SDPs should capture all data accurately for a complete and comprehensive analysis.
3.8 REFERENCE
1. Manual National Indicator Approach and Key Performance Indicators. Obstetrics and Gynaecology, Ministry of Health 2010.
2. 2
nd
NOR Report 2010. Editors: Dr Ravichandran Jeganathan, Dr Shamala Devi Karalasingam
29
