Maternal Outcomes of Postpartum Hemorrhage After Vaginal Delivery in Lusaka, Zambia: A Hospital-Level Comparison

Introduction: Postpartum hemorrhage is the leading contributor to maternal morbidity and mortality worldwide, with the burden greatest in low-resource settings. In Zambia, maternal mortality remains above national and global targets, and PPH is a major contributor. While most studies emphasize predictors and prevalence, limited evidence exists on maternal outcomes across different levels of care. This study aimed to examine maternal outcomes of Postpartum hemorrhage following vaginal delivery in first-level and tertiary hospitals in Lusaka. Methods: We employed a quantitative, case-control study cross-sectionally on 318 women who delivered vaginally at firstlevel and tertiary hospitals in Lusaka, Zambia. Data were collected using structured questionnaires and analyzed with descriptive statistics, correlations, and regression. Cases and controls were comparable across baseline variables. Results: Among Postpartum hemorrhage cases, 56.8% required blood transfusion, 11% developed hemorrhagic shock, 3.8% underwent hysterectomy, and 3.8% died. Adverse outcomes occurred exclusively among cases. Accessibility and provider competence were negatively correlated with complications, while regression analysis identified uterine atony (OR = 2.8, 95% CI: 1.4–5.6), referral delays >2 hours (OR = 3.5, 95% CI: 1.7–7.2), and lack of blood availability (OR = 4.2, 95% CI: 2.0–8.9) as the strongest predictors of the mortality outcome. Conclusion: Postpartum hemorrhage imposes a severe burden on first-level hospitals, with blood transfusion demand, referral delays, and systemic gaps driving poor outcomes. Strengthening blood bank infrastructure, improving referral pathways, and continuous provider training are critical to reducing preventable maternal deaths.