ABSTRACT
This study was carried out to investigate the
prevalence and outcome of postpartum haemorrhage among women who delivered in Federal
Teaching Hospital Abakaliki from 2004 to 2013. It was a retrospective
descriptive study of 588 women comprising all cases of PPH in the course of
childbirth as recorded in FETHA from 2004 to 2013. A structured proforma was
used to extract the required information from patients’ case files. Frequency Tables
and percentages were used for the descriptive statistics, while Chi-squared
test and logistic regression were used to test the hypotheses at 0.05 level of
significance with the aid of IBM SPSS Statistics 20. The major findings showed
that the prevalence of PPH for the period of study was 3.7% and it was at the
peak in 2010 (5.6%) and lowest in 2005 (1.9%). The prevalence of PPH was
significantly higher (P<0.05) after Pathfinder Project in 2009-2013 (4.5%)
when compare to before the project in 2004-2008 (3.0%). Parity (2-5) and
booking status of the women were significantly associated with PPH in
childbirth (P<0.05). Advanced maternal age and occupation that demand hard
labour are vulnerable to PPH. Trauma was the highest documented immediate cause
of PPH (32.7%), while TBAs interference was the highest remote cause (20.4%).
Primary PPH was common among these women (99.5%). Timely and quality
intervention measures such as use of uterotonics (38.1%), use of antibiotics
(25.5%), surgery (16.5%) and replacement therapy (12.4%) were employed to
achieve very good outcome as most patients (94.6%) were discharged home while
the death rate was 3.1%. It was recommended that the clinical and community
approach as employed by Pathfinder International in addressing postpartum
haemorrhage should be intensified by the healthcare professionals and
aggressive public awareness campaign should also be conducted by the health
care professionals to stop TBAs patronage.
TABLE OF CONTENTS
Title
Table of Contents
List of Tables
List of Figures
Abstract
CHAPTER ONE: INTRODUCTION
Background of the Study
Statement of the Problem
Purpose of the Study
Study Objectives
Research Questions
Hypotheses
Significance of the Study
Scope of the Study
Operational Definition of Terms
CHAPTER TWO: LITERATURE REVIEW
Conceptual Review
Theoretical Framework to Support the Study
Empirical Review on the Study
Summary of Literature Reviewed
CHAPTER THREE: RESEARCH METHODS
Research Design
Area of Study
Population of Study
Sample Size
Sampling Technique
Instrument for Data Collection
Validation of Instrument
Reliability of Instrument
Ethical Consideration
Procedure for Data Collection
Method of Data Analysis
CHAPTER FOUR: PRESENTATION OF RESULTS
Demographic Characteristics of the Women who Had PPH
Obstetric/ Clinical Status of Women that Had PPH
Objective 1
Objective 2
Objective 3
Objective 4
Objective 5
Objective 6
Test of Hypotheses
Summary of Major Findings
CHAPTER FIVE: DISCUSSION OF FINDINGS, CONCLUSION AND RECOMMENDATIONS
Socio-Demographic Characteristics
Obstetrics/ Clinical Status
Objective 1
Objective 2
Objective 3
Objective 4
Objective 5
Objective 6
Conclusion
Recommendations
Limitation of the Study
Suggestions for Further Studies
References
Appendices
CHAPTER ONE
INTRODUCTION
Background to the study
Postpartum haemorrhage (PPH) is an obstetric emergency that may follow vaginal or caesarean birth. The World Health Organization (WHO, 2014) defined PPH as the loss of more than 500mls of blood after vaginal delivery. PPH could occur within few hours of delivery of the baby or within 6 weeks postpartum, with uterine atony being the major cause (Healthline, 2012).
Postpartum haemorrhage has a global prevalence rate of 6% and 10.5% in Africa with associated case fatality of 1% and estimated to contribute about 25% of global maternal death (Clinical Practice Guideline, 2010). According to
Fawole, Awolude, Adeniji & Onafowokan (2010), PPH accounts for more than 30% of all maternal deaths and this varies considerably between developed and developing countries. It is the leading cause of maternal mortality and morbidity with highest prevalence in developing countries (Allan, 2010).This implies that Africa as a continent is lagging behind in containing maternal mortality due to postpartum haemorrhage. Maternal mortality is defined by WHO (2014) as the death of a woman while pregnant or within 42days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from incidental or accidental causes. The maternal mortality ratio (MMR) is the number of maternal deaths during a given period per 100,000 live births during the same time period (WHO, 2014).
The International Confederation of Midwives (ICM) stated that “every minute around the world, 380 women become pregnant, 110 women experience pregnancy related complications, and 1 woman dies”. This implies that 529,000 women die annually from pregnancy complication or childbirth. This is quite alarming! Ajefunja, Adepiti & Ogunniyi (2010), stated that an overwhelming proportion of about half a million women who die as a result of complications of pregnancy and childbirth, occur in developing countries where facilities are either poorly developed, or there is lack of trained attendants at delivery. Majority of these deaths occur within 24hours of delivery and in most cases are due to PPH (Ajefunja et al., 2010). According to the United Nations Population Fund Agency (UNFPA) reports in 2010, developing nations accounted for ninety-nine percent (99%) of maternal deaths with majority of these deaths occurring in sub-Saharan Africa and Southern Asia. Nigeria was rated second highest contributor with 14% or 40,000 deaths while India was first with 19% or 56,000 deaths.
The burden of postpartum haemorrhage on developing countries cannot be overemphasized. Many women have lost their lives, some have lost their uterus and many who survived it, are faced with one health challenge or the other. Many children have also been rendered motherless and many families suffer pain. It is not out of place to say that PPH is also a social menace because marriages have been broken in some cases of uterine loss, children have been neglected or abandoned in some cases of maternal deaths and often, there is society-directed violence when many families suffer pain. Fathalla as reported in Obinna (2014) stated that women are not dying because of the disease that cannot be treated, but are dying because the society is yet to make the decision that their lives are worth saving. This implies that PPH as the highest contributor to maternal deaths could be prevented to make childbirth safer.
The intervention to prevent PPH in developing countries is no doubt pivotal in the global effort to achieve the millennium development goal (MDG5) of reducing maternal mortality ratio by three quarters by 2015 from 1990. Also foremost among the objectives of the nation’s policy on reproductive health is, to reduce maternal morbidity due to pregnancy and childbirth by 50%. The International Federation of Obstetricians and Gynaecologists (FIGO) and the International Confederation of Midwives (ICM) in collaboration with WHO, have recommended active management of the third stage of labour (AMTSL) and routine use of uterotonics for prevention of PPH (PATHS, 2014). However the low socio-cultural and economic status of women as well as the inadequacies of our existing health systems, have contributed to the delays that lead to complications and the death of women with PPH (WHO, 2014)......
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