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Pg1}{\bkmkend Pg1}\par\pard\ql \li1196\sb0\sl-253\slmult0 \par\pard\ql\li1196\sb0\sl-253\slmult0 \par\pard\ql\li1196\sb244\sl-253\slmult0 \up0 \expndtw0\charscalex100 \ul0\nosupersub\cf5\f6\fs22 Vol 37, No 1 \par\pard\li1196\sb1\sl-253\slmult0\fi0\tx6379\tx10924 \up0 \expndtw-2\charscalex100 January 2013\tab \up0 \expndtw-2\charscalex100 Morbidity occurs to a fifth of referred PPH cases\tab \up0 \expndtw-2\charscalex100 3\par\pard\ql \li1328\sb0\sl-230\slmult0 \par\pard\ql\li1328\sb82\sl-230\slmult0 \up0 \expndtw-3\charscalex100 \ul0\nosupersub\cf1\f2\fs20 Research Article \par\pard\ql \li1524\sb0\sl-322\slmult0 \par\pard\ql\li1524\sb52\sl-322\slmult0 \up0 \expndtw-2\charscalex100 \ul0\nosupersub\cf2\f3\fs28 Morbidity Occurs to a Fifth of Referred Post Partum Hemorrhage Cases \par\pard\ql \li1826\sb176\sl-276\slmult0 \up0 \expndtw-2\charscalex100 \ul0\nosupersub\cf3\f4\fs24 Morbiditas terjadi pada Seperlima Kasus Rujukan Perdarahan Pascapersalinan \par\pard\ql \li4616\sb243\sl-253\slmult0 \up0 \expndtw-2\charscalex100 \ul0\nosupersub\cf4\f5\fs22 Fitri Rahardja, Omo A. Madjid \par\pard\ql \li4112\ri3589\sb82\sl-260\slmult0\fi122\tx4553 \up0 \expndtw-3\charscalex100 \ul0\nosupersub\cf5\f6\fs22 Department of Obstetrics and Gynecology \up0 \expndtw-3\charscalex100 Faculty of Medicine University of Indonesia/ \line\tab \up0 \expndtw-3\charscalex100 Dr. Cipto Mangunkusumo Hospital \par\pard\ql \li5782\sb6\sl-253\slmult0 \up0 \expndtw-5\charscalex100 Jakarta\par\pard\sect\sectd\sbknone\cols2\colno1\colw6196\colsr160\colno2\colw5404\colsr160\ql \li1196\sb0\sl-253\slmult0 \par\pard\ql \li1196\sb0\sl-253\slmult0 \par\pard\ql \li1196\sb131\sl-253\slmult0 \up0 \expndtw-5\charscalex100 \ul0\nosupersub\cf4\f5\fs22 Abstract\par\pard\qj \li1196\sb0\sl-170\slmult0 \par\pard\qj \li1196\ri266\sb97\sl-170\slmult0 \up0 \expndtw-4\charscalex100 \ul0\nosupersub\cf9\f10\fs17 Objective\ul0\nosupersub\cf10\f11\fs17 : To assess maternal morbidity (five scoring system) and \up0 \expndtw-2\charscalex100 mortality of referred post partum hemorrhage (PPH) in Dr. Cipto \up0 \expndtw0\charscalex102 Mangunkusumo Hospital period 2008-2010 and to identify its \up0 \expndtw-5\charscalex100 related factors.\par\pard\qj \li1196\ri266\sb91\sl-170\slmult0 \up0 \expndtw-1\charscalex100 \ul0\nosupersub\cf9\f10\fs17 Method\ul0\nosupersub\cf10\f11\fs17 : Retrospective study with cross sectional design for re-\line \up0 \expndtw-3\charscalex100 ferred obstetric cases in RSCM period 2008-2010. Analysis of rela-\line \up0 \expndtw-1\charscalex100 tion was conducted to these data using Chi-square or Fisher test \up0 \expndtw-4\charscalex100 with SPSS 17.0.\par\pard\qj \li1196\ri266\sb89\sl-170\slmult0\fi0 \up0 \expndtw-4\charscalex100 \ul0\nosupersub\cf9\f10\fs17 Result\ul0\nosupersub\cf10\f11\fs17 : There were 10,752 referred obstetrics cases in RSCM from \line \up0 \expndtw-4\charscalex100 2008-2010, the three most common cases were severe preeclamp-\line \up0 \expndtw-4\charscalex100 sia, premature rupture of membrane, and preterm labour. The rate \line \up0 \expndtw-2\charscalex100 of referred cases of PPH in RSCM from 2008-2010 was 2%. There \line \up0 \expndtw-6\charscalex100 were 44 cases (20.5%) suffering morbidity (five scoring system) and\par\pard\qj \li1196\ri266\sb2\sl-169\slmult0 \up0 \expndtw-5\charscalex100 3 cases ending in mortality (1.4%) from all PPH referral cases. Mor-\line \up0 \expndtw-3\charscalex100 tality to morbidity rate for referred PPH cases in RSCM was 6.81% \up0 \expndtw-5\charscalex100 (3/44) with case/fatality ratio 14.7: 1. Variables that related to mor-\line \up0 \expndtw-4\charscalex100 bidity were age and referral factors (midwife). There were no rela-\line \up0 \expndtw-5\charscalex100 tion between parity, education background, pay of services, occupa-\line \up0 \expndtw-4\charscalex100 tion, type and etiology of PPH with morbidity due to PPH. Mortality \up0 \expndtw-5\charscalex100 assesment for 3 PPH referred cases would be descriptive.\par\pard\qj \li1196\ri266\sb92\sl-169\slmult0 \up0 \expndtw-3\charscalex100 \ul0\nosupersub\cf9\f10\fs17 Conclusion\ul0\nosupersub\cf10\f11\fs17 : The proportion of referred PPH cases in RSCM 2008-\line \up0 \expndtw-2\charscalex100 2010 was 2%, of which 20.5% classified as morbid and 1.4% was \up0 \expndtw-5\charscalex100 classified as mortal cases. Variables related significantly to morbidity \up0 \expndtw-5\charscalex100 were age and referral factors.\par\pard\ql \li1196\sb72\sl-195\slmult0 \up0 \expndtw-5\charscalex100 [Indones J Obstet Gynecol 2013; 37-1: 3-7]\par\pard\qj \li1196\ri270\sb85\sl-170\slmult0 \up0 \expndtw-5\charscalex100 \ul0\nosupersub\cf9\f10\fs17 Keywords\ul0\nosupersub\cf10\f11\fs17 : five scoring system, maternal morbidity, maternal mor-\line \up0 \expndtw-5\charscalex100 tality, referred cases of PPH\par\pard\column \ql \li6356\sb0\sl-253\slmult0 \par\pard\ql \li6356\sb0\sl-253\slmult0 \par\pard\ql \li20\sb131\sl-253\slmult0 \up0 \expndtw-5\charscalex100 \ul0\nosupersub\cf11\f12\fs22 Abstrak\par\pard\qj \li6356\sb0\sl-170\slmult0 \par\pard\qj \li20\ri661\sb97\sl-170\slmult0 \up0 \expndtw-3\charscalex100 \ul0\nosupersub\cf12\f13\fs17 Tujuan\ul0\nosupersub\cf13\f14\fs17 : Mengetahui kejadian morbiditas (berdasarkan five scoring \up0 \expndtw-4\charscalex100 system) dan mortalitas pada kasus rujukan perdarahan pascapersa-\line \up0 \expndtw-2\charscalex100 linan (HPP) di RSCM tahun 2008-2010 dan faktor-faktor yang me-\line \up0 \expndtw-5\charscalex100 mengaruhinya.\par\pard\qj \li20\ri660\sb81\sl-170\slmult0\fi0 \up0 \expndtw-5\charscalex100 \ul0\nosupersub\cf12\f13\fs17 Metode\ul0\nosupersub\cf13\f14\fs17 : Studi retrospektif dengan desain potong lintang pada kasus-\line \up0 \expndtw0\charscalex100 kasus obstetrik rujukan ke RSCM periode 2008-2010. Analisis hu-\line \up0 \expndtw-5\charscalex100 bungan menggunakan uji Chi-square atau Fisher dengan SPSS 17.0.\par\pard\qj \li20\ri660\sb81\sl-169\slmult0 \up0 \expndtw-5\charscalex100 \ul0\nosupersub\cf12\f13\fs17 Hasil\ul0\nosupersub\cf13\f14\fs17 : Terdapat 10752 kasus rujukan obstetri di RSCM periode 2008-\line \up0 \expndtw-6\charscalex100 2010, tiga terbanyak preeklampsia berat, ketuban pecah dini dan per-\line \up0 \expndtw-4\charscalex100 salinan preterm. Proporsi kasus rujukan HPP di RSCM adalah 2%, 44 \line \up0 \expndtw-4\charscalex100 kasus (20,5%) termasuk ke dalam morbiditas berdasarkan five scor-\line \up0 \expndtw-2\charscalex100 ing system sedangkan mortalitasnya terdapat pada 3 kasus (1,4%) \line \up0 \expndtw-5\charscalex100 dari seluruh kasus rujukan HPP. Rate kematian ibu terhadap morbidi-\line \up0 \expndtw-4\charscalex100 tas kasus rujukan HPP adalah 6.81% (3/44) dengan case/fatality ra-\line \up0 \expndtw-4\charscalex100 tio 14.7 : 1. Dari ketiga faktor, yang berhubungan dengan morbiditas \line \up0 \expndtw-5\charscalex100 akibat HPP adalah faktor usia dan perujuk (midwife). Tidak terdapat \line \up0 \expndtw-5\charscalex100 hubungan bermakna paritas, pendidikan, cara bayar, pekerjaan, jenis \line \up0 \expndtw-6\charscalex100 HPP dan etiologi HPP dengan morbiditas akibat HPP. Analisis mortali-\line \up0 \expndtw-5\charscalex100 tas terhadap kasus rujukan dilakukan secara deskriptif pada 3 kasus.\par\pard\qj \li20\ri661\sb82\sl-170\slmult0 \up0 \expndtw-6\charscalex100 \ul0\nosupersub\cf12\f13\fs17 Kesimpulan\ul0\nosupersub\cf13\f14\fs17 : Proporsi kasus rujukan HPP di RSCM periode 2008-2010 \up0 \expndtw-2\charscalex100 adalah 2%, sebanyak 20.5% mengalami morbiditas dan mortalitas \up0 \expndtw-2\charscalex100 pada 1.4% kasus. Variabel yang memiliki hubungan bermakna de-\line \up0 \expndtw-5\charscalex100 ngan morbiditas adalah usia dan faktor perujuk.\par\pard\ql \li20\sb61\sl-195\slmult0 \up0 \expndtw-5\charscalex100 [Maj Obstet Ginekol Indones 2013; 37-1: 3-7]\par\pard\qj \li20\ri665\sb76\sl-170\slmult0\fi0 \up0 \expndtw-2\charscalex100 \ul0\nosupersub\cf12\f13\fs17 Kata kunci\ul0\nosupersub\cf13\f14\fs17 : five scoring system, morbiditas ibu, mortalitas ibu, ru-\line \up0 \expndtw-4\charscalex100 jukan HPP \par\pard\sect\sectd\sbknone \qj \li1196\sb0\sl-180\slmult0 \par\pard\qj\li1196\ri1644\sb150\sl-180\slmult0\fi0 \up0 \expndtw-4\charscalex100 \ul0\nosupersub\cf14\f15\fs18 Correspondence\ul0\nosupersub\cf15\f16\fs18 : Fitri Rahardja. Jln. Kenari I No. 19 Rt. 004 Rw. 001 Bekasi Timur 17113. Mobile phone: 08161891478, \up0 \expndtw-5\charscalex100 Email: pity_r@yahoo.com\par\pard\sect\sectd\sbknone\cols2\colno1\colw6196\colsr160\colno2\colw5404\colsr160\ql \li2714\sb0\sl-276\slmult0 \par\pard\ql \li2714\sb0\sl-276\slmult0 \par\pard\ql \li2714\sb0\sl-276\slmult0 \par\pard\ql \li2714\sb42\sl-276\slmult0 \up0 \expndtw-5\charscalex100 \ul0\nosupersub\cf6\f7\fs24 INTRODUCTION\par\pard\qj \li1196\ri246\sb154\sl-282\slmult0\fi0 \up0 \expndtw-5\charscalex100 \ul0\nosupersub\cf7\f8\fs22 In developing countries like Indonesia, post partum \line \up0 \expndtw-5\charscalex100 hemorrhage has been a nightmare for obstetricians \line \up0 \expndtw-2\charscalex100 even in a woman without any previously detected \line \up0 \expndtw-4\charscalex100 risk factor.\ul0\super\cf8\f9\fs23 1,2\ul0\nosupersub\cf7\f8\fs22 Maternal mortality ratio in Indonesia \line \up0 \expndtw-3\charscalex100 was the highest among Southeast Asian Countries, \line \up0 \expndtw0\charscalex103 which is 228/100.000 live birth, based on SDKI \line \up0 \expndtw-5\charscalex100 2007.\ul0\super\cf8\f9\fs23 3\ul0\nosupersub\cf7\f8\fs22 PPH was the major cause (43%) of maternal \line \up0 \expndtw0\charscalex102 mortality in Indonesia, starting in 1998 up until \line \up0 \expndtw-5\charscalex100 now.\ul0\super\cf8\f9\fs23 2\par\pard\ql \li6080\sb111\sl-253\slmult0 \up0 \expndtw-3\charscalex100 \ul0\nosupersub\cf4\f5\fs22 |\par\pard\column \qj \li6596\sb0\sl-267\slmult0 \par\pard\qj \li6596\sb0\sl-267\slmult0 \par\pard\qj \li6596\sb0\sl-267\slmult0 \par\pard\qj \li20\ri641\sb239\sl-267\slmult0\fi240 \up0 \expndtw-2\charscalex100 \ul0\nosupersub\cf7\f8\fs22 Traditionally PPH defined as bleeding > 500 ml \up0 \expndtw0\charscalex101 after placenta expulsion for vaginal delivery and \up0 \expndtw-4\charscalex100 >1000 ml for C-section, its been hard to asses since \up0 \expndtw0\charscalex100 the assesment was too subjective and underesti-\line \up0 \expndtw0\charscalex102 mate. Nowadays definition has been changed to \up0 \expndtw0\charscalex100 any bleeding that significantly changed hemody-\line \up0 \expndtw-2\charscalex100 namic of the body.\ul0\super\cf8\f9\fs23 4\par\pard\qj \li20\ri643\sb121\sl-267\slmult0\fi240 \up0 \expndtw-4\charscalex100 \ul0\nosupersub\cf7\f8\fs22 Many factors contributed to maternal morbidity \line \up0 \expndtw-2\charscalex100 and mortality in Indonesia, not just obstetrical as-\line \up0 \expndtw0\charscalex102 pect but also non obstetrical factors such as cul-\par\pard\sect\sectd\fs24\paperw11900\paperh16840{\shp{\*\shpinst\shpleft740\shptop1480\shpright10740\shpbottom1640\shpwr3\shpfblwtxt0\shpbxpage\shpbypage\shpz499\shplid1{\sp{\sn shapeType}{\sv 75}}{\sp{\sn fBehindDocument}{\sv 1}}{\sp{\sn pib}{\sv 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Pg2}{\bkmkend Pg2}\par\pard\ql \li9849\sb0\sl-253\slmult0 \par\pard\ql\li9849\sb0\sl-253\slmult0 \par\pard\ql\li9849\sb244\sl-253\slmult0 \up0 \expndtw-3\charscalex100 \ul0\nosupersub\cf18\f19\fs22 Indones J \par\pard\li836\sb1\sl-253\slmult0\fi0\tx9344 \up0 \expndtw-2\charscalex100 4 Rahardja and Madjid\tab \up0 \expndtw-2\charscalex100 Obstet Gynecol\par\pard\sect\sectd\sbknone\cols2\colno1\colw5836\colsr160\colno2\colw5764\colsr160\qj \li836\ri247\sb180\sl-259\slmult0\fi0 \up0 \expndtw-4\charscalex100 \ul0\nosupersub\cf16\f17\fs22 tural perception, financial problem and geographi-\line \up0 \expndtw-2\charscalex100 cal factor.\ul0\super\cf17\f18\fs23 5\ul0\nosupersub\cf16\f17\fs22 Referral factors also play an important \line \up0 \expndtw0\charscalex100 role for morbidity and mortality of PPH cases. In \line \up0 \expndtw0\charscalex103 Indonesia, a referral system was already estab-\line \up0 \expndtw-2\charscalex100 lished for obstetrical cases, started at \ul0\nosupersub\cf18\f19\fs22 pondok ber-\line \up0 \expndtw-3\charscalex100 salin desa\ul0\nosupersub\cf16\f17\fs22 (POLINDES) implemented by a midwife, \line \up0 \expndtw-3\charscalex100 primary health care with basic obstetrics and neo-\line \up0 \expndtw-4\charscalex100 natal services or \ul0\nosupersub\cf18\f19\fs22 pelayanan obstetri neonatal emer-\line \up0 \expndtw-1\charscalex100 gensi dasar\ul0\nosupersub\cf16\f17\fs22 (PONED) with at least one doctor and \line \up0 \expndtw-3\charscalex100 midwife, hospital services with specialized obstet-\line \up0 \expndtw-2\charscalex100 ric and neonatal emergency services or \ul0\nosupersub\cf18\f19\fs22 pelayanan \line \up0 \expndtw-5\charscalex100 obstetri neonatal emergensi khusus\ul0\nosupersub\cf16\f17\fs22 (PONEK) imple-\line \up0 \expndtw-1\charscalex100 mented by an obgyn and midwife, and finally, the \line \up0 \expndtw-5\charscalex100 last resort is tertiary hospital care like Rumah Sakit \line \up0 \expndtw-3\charscalex100 Dr. Cipto Mangunkusumo (RSCM).\ul0\super\cf17\f18\fs23 6\par\pard\qj \li836\ri247\sb121\sl-259\slmult0\fi240 \up0 \expndtw-3\charscalex100 \ul0\nosupersub\cf16\f17\fs22 With these implemented system, morbidity and \up0 \expndtw-3\charscalex100 mortality due to PPH should be reduced, but as we \up0 \expndtw-4\charscalex100 mentioned before, there are lots of factors contrib-\line \up0 \expndtw0\charscalex100 uted to the cause, not only obstetric but also non \up0 \expndtw-4\charscalex100 obstetric factors.\par\pard\qj \li836\ri248\sb152\sl-259\slmult0\fi240 \up0 \expndtw-5\charscalex100 Maternal mortality has been the target of studies \line \up0 \expndtw-1\charscalex100 and became a health indicator in many countries, \line \up0 \expndtw0\charscalex107 but actually the number of morbidity is much \line \up0 \expndtw0\charscalex100 higher. Study of the morbidity rate is also impor-\line \up0 \expndtw-4\charscalex100 tant and could be an alternative or complementary \line \up0 \expndtw0\charscalex100 to the study of maternal death events as a health \line \up0 \expndtw-3\charscalex100 indicator. By identifying a large number of women \line \up0 \expndtw0\charscalex101 with morbidity, study of morbidity will improve \line \up0 \expndtw-3\charscalex100 the opportunity to preventability of both maternal \line \up0 \expndtw-4\charscalex100 morbidity and mortality.\ul0\super\cf17\f18\fs23 7,8\par\pard\qj \li836\ri247\sb150\sl-259\slmult0\fi240 \up0 \expndtw-1\charscalex100 \ul0\nosupersub\cf16\f17\fs22 Criteria for morbidity is still a controversy, but \up0 \expndtw-5\charscalex100 the five scoring system so far has the highest speci-\line \up0 \expndtw-1\charscalex100 ficity (93.3%) and sensitivity 100%.\ul0\super\cf17\f18\fs23 9\ul0\nosupersub\cf16\f17\fs22 The scoring \up0 \expndtw-2\charscalex100 system would be described in Table 1.\par\pard\ql \li836\ri571\sb266\sl-378\slmult0\tx2271\tx4609 \up0 \expndtw-4\charscalex100 \ul0\nosupersub\cf19\f20\fs19 Table 1.\ul0\nosupersub\cf20\f21\fs19 Weighting for the Five Scoring system \line\tab \up0 \expndtw-5\charscalex100 \ul0\nosupersub\cf21\f22\fs18 Criteria \tab \up0 \expndtw-5\charscalex100 Scoring\par\pard\ql \li1227\sb74\sl-207\slmult0\tx4863 \up0 \expndtw-5\charscalex100 \ul0\nosupersub\cf15\f16\fs18 Organ system failure (\ul0\nosupersub\cf22\f23\fs16 \u8805?\ul0\nosupersub\cf15\f16\fs18 1 organ)\tab \up0 \expndtw-2\charscalex100 5\par\pard\ql \li1227\sb104\sl-207\slmult0\tx4863 \up0 \expndtw-5\charscalex100 ICU admission\tab \up0 \expndtw-2\charscalex100 4\par\pard\ql \li1227\sb102\sl-207\slmult0\tx4864 \up0 \expndtw-5\charscalex100 Tranfussion > 3 unit\tab \up0 \expndtw-2\charscalex100 3\par\pard\ql \li1227\sb104\sl-207\slmult0\tx4863 \up0 \expndtw-5\charscalex100 Extended intubation (\ul0\nosupersub\cf22\f23\fs16 \u8805?\ul0\nosupersub\cf15\f16\fs18 12 hours)\tab \up0 \expndtw-2\charscalex100 2\par\pard\ql \li1227\sb103\sl-207\slmult0\tx4863 \up0 \expndtw-5\charscalex100 Surgical intervention (hysterectomy)\tab \up0 \expndtw-2\charscalex100 1\par\pard\qj \li836\ri351\sb137\sl-169\slmult0\fi0 \up0 \expndtw-3\charscalex100 \ul0\nosupersub\cf23\f24\fs16 *total scoring Five scoring system \ul0\nosupersub\cf22\f23\fs16 \u8805?\ul0\nosupersub\cf23\f24\fs16 3 classified as severe morbidity and \up0 \expndtw-3\charscalex100 \ul0\nosupersub\cf22\f23\fs16 \u8805?\ul0\nosupersub\cf23\f24\fs16 8 as near miss morbidity.\par\pard\qj \li836\sb0\sl-260\slmult0 \par\pard\qj \li836\ri248\sb123\sl-260\slmult0\fi240 \up0 \expndtw0\charscalex100 \ul0\nosupersub\cf16\f17\fs22 For the analysis, severe and near miss cases of \up0 \expndtw-3\charscalex100 morbidity were classified as morbidity.\par\pard\qj \li836\ri247\sb150\sl-260\slmult0\fi240 \up0 \expndtw0\charscalex101 The data of referred cases of PPH in a tertiary \line \up0 \expndtw-4\charscalex100 hospital care like RSCM was still not available, thus\par\pard\ql \li5720\sb115\sl-253\slmult0 \up0 \expndtw-3\charscalex100 \ul0\nosupersub\cf24\f25\fs22 |\par\pard\column \qj \li20\ri1001\sb180\sl-259\slmult0 \up0 \expndtw-3\charscalex100 \ul0\nosupersub\cf16\f17\fs22 this research will help us to get an overview of ob-\line \up0 \expndtw-4\charscalex100 stetrics referral system in Jakarta and surrounding \line \up0 \expndtw0\charscalex100 areas, identifying morbidity and mortality due to \line \up0 \expndtw0\charscalex100 PPH and its related factors. Hopefully, in the end, \line \up0 \expndtw-2\charscalex100 it would improve our services for maternal health \line \up0 \expndtw-3\charscalex100 in Indonesia.\par\pard\ql \li5996\sb0\sl-276\slmult0 \par\pard\ql \li1889\sb90\sl-276\slmult0 \up0 \expndtw-4\charscalex100 \ul0\nosupersub\cf6\f7\fs24 METHOD\par\pard\qj \li20\ri1001\sb138\sl-260\slmult0 \up0 \expndtw-5\charscalex100 \ul0\nosupersub\cf16\f17\fs22 This study was conducted in Obstetrics-Gynecology \up0 \expndtw0\charscalex105 Department, Faculty of Medicine, University of \up0 \expndtw-1\charscalex100 Indonesia, through January 2011 - October 2011. \up0 \expndtw-3\charscalex100 The data was secondary data from medical record \up0 \expndtw-2\charscalex100 dated back from 2008 until 2010.\par\pard\qj \li20\ri1002\sb119\sl-260\slmult0\fi240 \up0 \expndtw-1\charscalex100 This study was a cross sectional study. All data \up0 \expndtw0\charscalex100 of referred obstetric cases were taken from elec-\line \up0 \expndtw0\charscalex107 tronic data that have been collected before by \up0 \expndtw-2\charscalex100 medical records team of RSCM. Samples for all re-\line \up0 \expndtw0\charscalex100 ferred cases of PPH was calculated, and it is esti-\line \up0 \expndtw0\charscalex103 mated that the minimum requirement was 192 \up0 \expndtw-1\charscalex100 samples. But we finally decide to take all referred \up0 \expndtw-3\charscalex100 PPH cases in 2008-2010 consecutively.\par\pard\qj \li7170\sb0\sl-256\slmult0 \par\pard\qj \li7170\sb0\sl-256\slmult0 \par\pard\qj \li1194\ri2192\sb74\sl-256\slmult0\tx1276 \up0 \expndtw-5\charscalex100 10,752 referred obstetric \line\tab \up0 \expndtw-4\charscalex100 cases from 2008 - 2010\par\pard\qj \li7268\sb0\sl-256\slmult0 \par\pard\qj \li7268\sb0\sl-256\slmult0 \par\pard\qj \li7268\sb0\sl-256\slmult0 \par\pard\qj \li7268\sb0\sl-256\slmult0 \par\pard\qj \li1292\ri2251\sb84\sl-256\slmult0\tx1565 \up0 \expndtw-4\charscalex100 215 referred PPH cases \line\tab \up0 \expndtw-3\charscalex100 from 2008 - 2010\par\pard\ql \li5996\sb0\sl-256\slmult0 \par\pard\ql \li5996\sb0\sl-256\slmult0 \par\pard\ql \li5996\sb0\sl-256\slmult0 \par\pard\ql \li5996\sb0\sl-256\slmult0 \par\pard\ql \li1042\ri2024\sb84\sl-256\slmult0\fi269 \up0 \expndtw-5\charscalex100 Analysis for morbidity, \line \up0 \expndtw-4\charscalex100 mortality and related factors\par\pard\qj \li5996\sb0\sl-273\slmult0 \par\pard\qj \li5996\sb0\sl-273\slmult0 \par\pard\qj \li20\ri1001\sb7\sl-273\slmult0\fi240 \up0 \expndtw0\charscalex101 Two hundred fifteen referred PPH cases were \line \up0 \expndtw-3\charscalex100 evaluated for univariate and bivariate analysis. All \line \up0 \expndtw0\charscalex102 result data were filled both in distribution table \line \up0 \expndtw0\charscalex101 and cross table that appropriate with the goal of \line \up0 \expndtw-1\charscalex100 this study, then analized using SPSS 17.0 with Chi \line \up0 \expndtw-4\charscalex100 square or Fisher test for bivariate analysis. The re-\line \up0 \expndtw0\charscalex101 sults will be in p value, odd ratio and 95% confi-\line \up0 \expndtw-4\charscalex100 dence interval.\par\pard\qj \li20\ri1002\sb122\sl-272\slmult0\fi240 \up0 \expndtw-1\charscalex100 All 215 cases were analyzed using Five scoring \up0 \expndtw-2\charscalex100 system classification, and concluded as morbidity, \up0 \expndtw-3\charscalex100 mortality or non morbidity and mortality. \par\pard\sect\sectd\fs24\paperw11900\paperh16840{\shp{\*\shpinst\shpleft1100\shptop1480\shpright11100\shpbottom1640\shpwr3\shpfblwtxt0\shpbxpage\shpbypage\shpz467\shplid2{\sp{\sn shapeType}{\sv 75}}{\sp{\sn fBehindDocument}{\sv 1}}{\sp{\sn pib}{\sv 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