Postpartum Hemorrhage; The Cause Of Maternal Death

Postpartum Hemorrhage; The Cause Of Maternal Death
Abstract
This study was carried out to examine postpartum hemorrhage; the cause of maternal death using General Hospital, Benin City as a case study. The study was specifically carried out to evaluate the prevalence of postpartum hemorrhage among women in Nigeria, identify the factors associated with increased risk of postpartum hemorrhage among women in Nigeria, determine the extent postpartum hemorrhage has resulted to maternal death, and evaluate the measures require to prevent postpartum hemorrhage among women in Nigeria. The survey design was adopted and the simple random sampling techniques were employed in this study. The population size comprise of nurses practicing at General Hospital, Benin City. In determining the sample size, the researcher conveniently selected 57 respondents and 50 were validated. Self-constructed and validated questionnaire was used for data collection. The collected and validated questionnaires were analyzed using frequency tables, and mean scores. While the hypotheses were tested using Chi-square statistical tool, SPPS v23. The result of the findings reveals that the factors associated with increased risk of postpartum hemorrhage among women in Nigeria includes: uterine atony, trauma, retained placental tissue, and coagulation disorders. Furthermore, the study revealed that the measures require to prevent postpartum hemorrhage among women in Nigeria includes: antenatal care, skilled birth attendance, active management of the third stage of labor (AMTSL), access to uterotonics, and postpartum monitoring. Therefore, it is recommended that healthcare institutions should enhance training programs for healthcare providers, including obstetricians, midwives, and nurses, on the prevention, early detection, and management of postpartum hemorrhage (PPH). Continuous professional development should be prioritized to ensure that all staff are up-to-date with the latest guidelines and techniques. To mention but a few.
Table of Content
- Title Page
- Certification
- Dedication
- Acknowledgement
- Table of Content
- List of Tables
- Abstract
Chapter One:
Introduction
- 1.1 Background of the Study
- 1.2 Statement of the Problem
- 1.3 Objective of the Study
- 1.4 Research Questions
- 1.5 Research Hypothesis
- 1.6 Significance of the Study
- 1.7 Scope of the Study
- 1.8 Limitation of the Study
- 1.9 Definition of Terms
- 1.10 Organisations of the Study
Chapter Two:
Review of Literature
- 2.1 Conceptual Framework
- 2.2 Theoretical Framework
- 2.3 Empirical Review
Chapter Three:
Research Methodology
- 3.1 Research Design
- 3.2 Population of the Study
- 3.3 Sample Size Determination
- 3.4 Sample Size Selection Technique and Procedure
- 3.5 Research Instrument and Administration
- 3.6 Method of Data Collection
- 3.7 Method of Data Analysis
- 3.8 Validity of the Study
- 3.9 Reliability of the Study
- 3.10 Ethical Consideration
Chapter Four:
Data Presentation and Analysis
- 4.1 Data Presentation
- 4.2 Analysis of Data
- 4.3 Answering Research Questions
- 4.4 Test of Hypotheses
Chapter Five:
Summary, Conclusion and Recommendation
- 5.1 Summary
- 5.2 Conclusion
- 5.3 Recommendation
- REFERENCES
- APPENDIX
- QUESTIONNAIRE
Chapter One
Introduction
1.1 Background of the Study
Maternal mortality is one of the greatest health and development challenges of developing countries including Nigeria. This is evident as Nigeria and India accounted for over one third of all maternal deaths worldwide in the year 2015, with an approximate 58,000 maternal deaths (19%) and 45,000 maternal deaths(15%), respectively (World Health Organisation (WHO), 2015). This implies that one Nigerian woman dies in childbirth every ten minutes.
Postpartum hemorrhage (PPH) is the leading cause of maternal mortality. All women who carry a pregnancy beyond 20 weeks’ gestation are at risk for PPH and its sequelae (Smith, 2018). Although maternal mortality rates have declined greatly in the developed world, PPH remains a leading cause of maternal mortality elsewhere. As the leading cause of morbidity and mortality in childbirth, it occurs in approximately 1% to 6% of all deliveries (Wormer et al., 2018).
Postpartum hemorrhage is divided into two types; primary and secondary postpartum hemorrhage. Primary postpartum hemorrhage occurs within 24 hours of delivery while secondary PPH occurs 24 hours to 6 weeks post-delivery. Primary postpartum hemorrhage contributes to 99% of most cases (Smith, 2018). Common causes of PPH are uterine atony, genital tract injuries, failure of the blood coagulation system, and trauma—the primary cause of PPH being uterine atony which accounts for 70% to 80% of hemorrhage (Wormer et al., 2018). Predisposing factors to PPH include; previous history, multiple pregnancy, large (macrocosmic) fetus, prime gravida, maternal age above 35 years, pre-term births, genital tract injuries, labour induction, and intrauterine fetal death (Ngwenya et al, 2016).
The American College of Obstetricians and Gynecologists (ACOG, 2016)defines early postpartum haemorrhage as at least 1,000 mls total blood loss or loss of blood coinciding with signs and symptoms of hypovolemia (that is, decrease in the volume of circulating blood) within 24 hours after delivery of the fetus or intrapartum loss. PPH is when the woman bleeds more than the ‘expected amount’ from the vagina and/or uterus after the baby is born. It can also include an excessive amount of blood loss during and/or after a Caesarean operation. Postpartum haemorrhage happens after the baby has been born, either before or after the placenta has been expelled from the uterus.
In Nigeria, PPH accounts for a substantial proportion of maternal deaths, with inadequate knowledge and awareness among childbearing women contributing to delays in seeking timely and appropriate medical care. Understanding the knowledge levels and causes of PPH among childbearing women in communities like Ihiala is crucial for developing targeted interventions to reduce maternal mortality rates.
1.2 Statement of the Problem
Globally, Postpartum hemorrhage is the leading cause of maternal mortality and accounts for one-quarter of maternal deaths. It affects 5% of all women giving birth around the world (Dadelszen et al, 2017). It is unacceptable for a woman to die due to an unpreventable condition, in society if a woman dies then this brings an impact to the family, community, and also the government (Ramanathan et al., 2018).
Postpartum hemorrhage (PPH) continues to be a leading cause of maternal mortality worldwide, particularly in low-resource settings such as Ihiala Community in Ihiala Local Government Area of Nigeria. Despite efforts to improve maternal healthcare, inadequate knowledge about the causes of PPH among childbearing women remains a significant challenge, leading to delays in seeking appropriate medical care and contributing to adverse maternal health outcomes. This lack of understanding among childbearing women in communities like Ihiala underscores the need for targeted interventions to address knowledge gaps and improve maternal health outcomes. To this end, this study seek to assess the knowledge and causes of post-partum haemorrhage among childbearing women in Ihiala Community, Ihiala Local Government Area.
1.3 Objective of the Study
The main objective of this study is to assess postpartum hemorrhage; the cause of maternal death, the researcher intends to achieve the following objectives;
- Evaluate the prevalence of postpartum hemorrhage among women in Nigeria.
- Identify the factors associated with increased risk of postpartum hemorrhage among women in Nigeria.
- Determine the extent postpartum hemorrhage has resulted to maternal death.
- Evaluate the measures require to prevent postpartum hemorrhage among women in Nigeria.
1.4 Research Question
The following questions will guide this study.
- What is the prevalence of postpartum hemorrhage among women in Nigeria?
- What are the factors associated with increased risk of postpartum hemorrhage among women in Nigeria?
- What is the extent postpartum hemorrhage has resulted to maternal death?
- What are the measures require to prevent postpartum hemorrhage among women in Nigeria?
1.5 Research Hypothesis
- Ho: The prevalence of postpartum hemorrhage among women in Nigeria is low.
- Ha: The prevalence of postpartum hemorrhage among women in Nigeria is high.
1.6 Significance of the Study
The significance of this study can not be over emphasized. The study will contribute significantly to maternal health outcomes in the region. Understanding the factors contributing to PPH is crucial for preventing and managing this potentially life-threatening condition, which remains a leading cause of maternal mortality globally. By identifying gaps in knowledge regarding the causes of PPH among childbearing women in Ihiala Community, healthcare providers can develop targeted educational interventions to improve awareness and promote early detection and appropriate management of PPH cases. Ultimately, enhancing knowledge about PPH among childbearing women can lead to better health-seeking behaviors, timely access to healthcare services, and improved maternal health outcomes in Ihiala Local Government.
1.7 Scope of the Study
The study focuses on the assessment of postpartum hemorrhage; the cause of maternal death. Hence the study will be delimited to nurses practicing at General Hospital, Benin City.
1.8 Limitation of the Study
Like in every human endeavour, the researcher encountered slight constraints while carrying out the study. Insufficient funds tend to impede the efficiency of the researcher in sourcing for the relevant materials, literature, or information and in the process of data collection, which is why the researcher resorted to a limited choice of sample size. More so, the researcher simultaneously engaged in this study with other academic work. As a result, the amount of time spent on research will be reduced.
Moreover, the case study method utilized in the study posed some challenges to the investigator including the possibility of biases and poor judgment of issues. However, the investigator relied on respect for the general principles of procedures, justice, fairness, objectivity in observation and recording, and weighing of evidence to overcome the challenges.
1.9 Definitions of Terms
Post-Partum Haemorrhage (PPH):
Post-partum hemorrhage refers to excessive bleeding following childbirth, typically defined as blood loss exceeding 500 milliliters within 24 hours of delivery. PPH can occur due to various factors, including uterine atony, retained placental tissue, genital tract trauma, and coagulation disorders.
1.10 Organization of the Study
The study is categorized into five chapters. The first chapter presents the background of the study, statement of the problem, objective of the study, research questions and hypothesis, the significance of the study, scope/limitations of the study, and definition of terms. The chapter two covers the review of literature with emphasis on conceptual framework, theoretical framework, and empirical review. Likewise, the chapter three which is the research methodology, specifically covers the research design, population of the study, sample size determination, sample size, and selection technique and procedure, research instrument and administration, method of data collection, method of data analysis, validity and reliability of the study, and ethical consideration. The second to last chapter being the chapter four presents the data presentation and analysis, while the last chapter(chapter five) contains the summary, conclusion and recommendation.
Chapter Five
Summary, Conclusions and Recommendations:
5.1 Introduction
This chapter summarizes the findings on postpartum hemorrhage; the cause of maternal death using General Hospital, Benin City as a case study. The chapter consists of summary of the study, conclusions, and recommendations.
5.2 Summary of the Study
This study, focus was to assess postpartum hemorrhage; the cause of maternal death using General Hospital, Benin City as a case study. The study was specifically carried out to evaluate the prevalence of postpartum hemorrhage among women in Nigeria, identify the factors associated with increased risk of postpartum hemorrhage among women in Nigeria, determine the extent postpartum hemorrhage has resulted to maternal death, and evaluate the measures require to prevent postpartum hemorrhage among women in Nigeria.
The study adopted the survey research design and randomly enrolled participants in the study. A total of 50 responses were validated from the enrolled participants where all respondent were nurses practicing at General Hospital, Benin City.
5.3 Conclusions
Based on the findings of this study, the researcher concluded that;
- The prevalence of postpartum hemorrhage among women in Nigeria is high.
- The factors associated with increased risk of postpartum hemorrhage among women in Nigeria includes: uterine atony, trauma, retained placental tissue, and coagulation disorders.
- The extent postpartum hemorrhage has resulted to maternal death is high.
- The measures require to prevent postpartum hemorrhage among women in Nigeria includes: antenatal care, skilled birth attendance, active management of the third stage of labor (AMTSL), access to uterotonics, and postpartum monitoring.
5.4 Recommendations
Based on the findings of the study, the following recommendations are proffered.
- Healthcare institutions should enhance training programs for healthcare providers, including obstetricians, midwives, and nurses, on the prevention, early detection, and management of postpartum hemorrhage (PPH). Continuous professional development should be prioritized to ensure that all staff are up-to-date with the latest guidelines and techniques.
- Hospitals and clinics should implement standardized protocols and guidelines for managing postpartum hemorrhage. These protocols should be evidence-based and include clear steps for prevention, identification, and treatment of PPH to ensure a uniform approach across all healthcare settings.
- Healthcare facilities should ensure the availability of essential medications and supplies required to manage postpartum hemorrhage. This includes uterotonic drugs, blood products, intravenous fluids, and surgical instruments. Regular audits should be conducted to maintain adequate stock levels.
- Antenatal care services should be strengthened to identify women at risk of postpartum hemorrhage early. Pregnant women should be screened for risk factors, and those identified at higher risk should receive appropriate monitoring and interventions throughout pregnancy and childbirth.
- Public health campaigns should promote community awareness and education about the signs and risks of postpartum hemorrhage. Women and their families should be educated on the importance of seeking immediate medical attention if symptoms of PPH occur after childbirth.
- Emergency response systems should be improved to ensure timely and efficient management of postpartum hemorrhage. This includes establishing rapid response teams, enhancing ambulance services, and ensuring quick referral systems from primary to tertiary care centers.


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