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TABLE OF CONTENTS
Title page i
Approval page ii
Table of contents viii
1.0 Introduction 1
1.1 Background of the study 2
1.2 Statement of the problem 5
1.3 Aim of the study 6
1.4 Objectives of the study 6
1.5 Significant of the study 7
1.6 Research question 7
1.7 Scope of the study 7
1.9 Limitation of the study 7
1.10 Definition of some major terms 9
2.0 LITERATURE REVIEW 9
2.1 Concept 9
2.2 Classification of post partum hemorrhage 9
2.3 Causes of post partum hemorrhage 10
2.4 Sign and symptoms 12
2.5 Presentation 12
2.6 Prevalence of post partum hemorrhage 14
2.7 Overview of anatomy and physiology of the uterus 16
2.8 Pathophysiology of postpartum hemorrhage 21
2.9 Management of postpartum hemorrhage 23
CHAPTER THREE: RESEARCH METHODOLOGY
3.0 Introduction 28
3.1 Research method 28
3.2 Area of the study 28
3.3 Population of the study 29
3.4 Sample size and sampling technique 29
3.5 Instrument for data collection 29
3.6 Validity of the instrument for data collection 30
3.7 Reliability of the instrument for data collection 30
3.8 Method of data analysis 30
4.0 Data presentation and analysis 31
4.1 Results 31
5.0 Summary, conclusion and recommendation 36
5.1 Introduction 36
5.2 Summary 36
5.3 Conclusion 37
5.4 Recommendations 38
Every woman experiences bleeding following child birth. However, if woman bleeds too much after given birth, it can lead to potentially life threatening condition known as postpartum haemorrhage. Post partum haemorrhage is the leading cause of childbirth related death in the world. Cause of child birth related death in the world. In developed continues, post partum haemorrhage accounts for approximately 10% of maternal deaths. While in developing countries, approximately one-forth of every maternal death are caused by the condition. Despite the community of post partum haemorahage, not every one is aware of the condition. Even those that are aware of the condition are often misinformed about the true fact regarding postpartum haemorrhage, for instance, many belief that post partum haemorrhage is a very serious condition that every woman needs to be aware of. Traditionally post partum haemorrhage is defined as a blood loss of more than 500ml following childbirth. However, research has shown many problems with this definition first, caregivers often underestimate the amount of blood loss by a mothers, secondly it is uncommon for patient to experience a blood loss of more than 500ml and suffer no ill effects. This is especially true for patient who undergoes a caesarian section in which blood loss of up to 1000ml would not be uncommon. On the other hand some patients have loss less than 500mls and suffered devastating effects to their health. Each individual has a different capacity to cope with blood loss. These finding have led to a broader definition of post-partum hemorrhage is now considered to be any loss in blood that results in symptoms of blood circulation, instability or any loss that threatens hydrodynamic (blood flow) stability, usually defined as greater than 1000mls. Postpartum hemorrhage is further defined as being either primary i.e occurring within 24hrs following delivery, or late i.e occurring between 24hrs and six weeks following delivery.
Background of the study
Post-partum hemorrhage (PPH) is an obstetric emergency that can follow original or cesarean delivery. It is a major cause of maternal morbidity and one of the five causes of maternal mortality. A quantitative definition is related to amount of blood loss in excess of 500mls following the birth of a baby or 1000mls after cesarean section.
Clinical definition states that any amount of a bleeding from the genital tract following birth of the baby up to the end of peupurium which adversely affects the general condition of the mother, evidenced by rise in pulse rate and falling blood pressure is called post-partum hemorrhage (Guesta C, 2008).
Post-partum hemorrhage is one of major causes of maternal morbidity and mortality, accounting for about one-third of all pregnancy-related deaths in Africa and Asia, post partum hemorrhage accounts for more than 30% of maternal death. Severe morbidities associated with PPH include anemia, disseminated intravascular coagulation, blood transfusion, hysterectomy and renal or liver failure.
Only about one-third of PPH cases have identifiable risk factors. These are believed to include a history of prior PPH, null parity, over distended uterus (e.g caused by multiple gestations or large baby), placental abnormalities, such as placenta previa, or placenta accreta, coagulation abnormalities, anemia, induction of labour, augmentation of labour, or use of an epidural, and prolonged labour. In spite of speculation to the contrary, high multiparity does not appear to be a risk factor. There are also no known risk factors to help predict which women will fail to respond to treatment with conventional uterotonics.
Uterine atony, failure of the uterus to contract after delivery, is the common cause of PPH. The prophylactic administration of a uterotonic has been shown to reduce the incidence of PPH through inducing uterine contractions. Oxytocin is considered the gold standard for prophylaxis, although ergometrine, methergyne, and misoprosol are also frequently used. When uterine atony occurs, the timely administration of a uterotonic drugs is recommended. Uterotonic treatment can help prevent the need for more sophisticated interventions, such as the administration of intervenous fluids, additional drug therapy, blood transfusion, and surgical intervention.
Although PPH occurs in all settings and all geographic regions, the majority of maternal deaths as a result of PPH take place in developing countries. This disparity has been attributed to differences in quality of care, including the availability of trained personnel attending deliveries, access to quality uterotonic drugs, and the timely receipt of needed interventions when obstetric emergencies arise. Yet disparities in severe maternal outcomes (SMOs) also occur within higher level health facilities.
Based on classifications, the PPH is classified into two and it depends on the time of occurrence, which include primary post-partum hemorrhage or true postpartum hemorrhage, is the bleeding that occur during the third stage of labour or within the 24 hours of delivery. While the other classification which termed as secondary postpartum hemorrhage is a bleeding that occur after 24 hours of delivery up to the sixth week of delivery (i.e peupurium). It is also known as late or delayed post-partum hemorrhage.
In term of sign symptoms, postpartum hemorrhage it sometimes visible bleeding which may be in form of copious continuous ooze, or intermittent gushes, rarely the bleeding is concealed either remaining inside the uterovesical canal or in the surrounding tissue space resulting in haematoma.
Hence prevention of post-partum haemorrhage (PPH) through greater use of active management of the third stage of labour can be expected to reduce maternal mortality, since approximately 65% of deliveries in developing countries are now supervised by a skilled health-care providers, it should be possible to expand the use of active management of the third stage of labour to prevent post-partum haemorrhage after delivery. Pragmatic (treating thing from a practical point of view) evidence based interventions are also needed to reduced post-partum haemorrhage rate in deliveries not attended by skilled provider. Such guidance aid clinical practical is not commonly available in developing countries.
Background of the study
The incidence of postpartum haemorrhage in observational studies is believed to be around 6%, although this can vary somewhat by geographic region and delivery setting.
In the recent world health organization (WHO) multi-country survey that documented the incidence of maternal morbidity and mortality at health facilities globally, post partum haemorrhage accounted for 27% of all deliveries with an severe maternal outcomes (SMOs). The aim of this analysis, therefore, was to explore the clinical practices, risks, and maternal outcomes associated with post partum haemorrhage.
Postpartum haemorrhage ranks high among the cause of maternal mortality, especially in Nigeria. The study is designed to determine the prevalence, management and outcomes of postpartum haemorrhage (PPH) in the study area.
Retained placental bits of tissue were major causes of postpartum hemorrhage which accounts for 52.4%. Major risk factors identified were multiple gestation which is 20%, antepartum hemorrhage also 15% and previous PPH accounts for 12.5%.
Uterotonic (ergometrine and /or syntocinon) was widely used 100% as first line of management with misoprosol being rarely used 7.3%. This study show that prior booking of pregnant women for ANC was associated with lower prevalence of PPH as higher prevalence was recorded among unbooked clients. Therefore, health workers most especially at the rural area must ensure that women are mobilized and encouraged to register for antenatal care as early as possible for appropriate maternity care, early identification of risk and preparation to reduce the untoward effects.
Statement of the problem
Postpartum hemorrhage is one of the leading causes of maternal mortality in Babbarika fulatan ward, Rogo Local Government Area. Although the rate of maternal mortality have now dropped in the developed countries. But in developing countries where there is lack of skilled health care providers along with poor transportation and emergency services, the condition is difficult to control and the number increases. Without the proper medical attention, the women with postpartum haemorrhage (bleeding after delivery) can die within two hours.
Efforts have been made by the people living in this community in order to reduce the incidence of this condition. World health organization suggests that as many as 25% of maternal deaths worldwide are caused by postpartum haemorrhage.
Aim of the study
1. To identify the major causes of post-partum delivery
2. To highlight the effects of post-partum hemorrhage as its relate to the aged
3. To assess the level of health care in place in the management of the third stage of labour.
Objectives of the study
1. To evaluate the World Health Organization post partum hemorrhage guidelines with the view to determine the value of the recommendation in reducing post-partum hemorrhage under resourced setting.
2. Training should be adequately provided to all staffs involved in maternity care concerning assessment of blood loss and the monitoring of women often childbirths. This is varying to reducing the severity of postpartum hemorrhage and preventing any adverse outcomes.
3. Proper management of third stage of labour help in reducing the incidence of postpartum hemorrhage after delivery.
Significant of the study
This research is very crucial tool for highlighting the problems, danger and complication of post-partum hemorrhage on the women of child bearing age.
The study will also encourage mothers to appreciate and have the knowledge on effect of postpartum hemorrhage and measures to be taking in order to prevent its occurrence.
The research will try as much as possible to provide the answers to the following questions.
1. What are the effects of post-partum hemorrhage?
2. How can maternal mortality be reduced?
3. How can deliveries be successful?
Scope of the study
This study will be on educating and highlighted both health care providers, traditional birth attendant as well as women of child bearing age on the effects associated with post-partum hemorrhage, so as to the desired objectives toward solving the problems associated with the condition.
Limitation of the study
1. Financial constraints:- Due to lack or insufficient funds for purchasing research materials, it hinders the appropriate findings.
2. Time:- The time of this research is so short, in view to this, the researcher could not cover many areas for more facts.
3. Insufficient facilities in the study area also hinder the research work.
Definition of some major terms
1. Postpartum: This is the period beginning immediately after the birth of a child and extending for about six weeks
2. Obstetrics:- Is a branch of medicine that deals with the birth of children and with the care of mother before, during and after they give birth to children.
3. Cesarean:- The delivery of a fetus by surgical incision through the abdominal wall and uterus.
4. Maternal mortality:- Is defined as the death of either a pregnant woman or death of a mother within 42 days of delivery.
5. Haemorrhage:- Is a condition in which a person bleeds too much and cannot stop the flow of blood.
6. Peupurium:- Is defined as the time from the delivery of the placenta through the six weeks after delivery.
7. Anemia:- This is condition in which the number of red blood cells or their oxygen – carrying capacity is sufficient to meet physiologic needs, which vary by age, sex, attitude, smoking and pregnancy status.
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