Abstract
Background: Postpartum Hemorrhage (PPH) is among the leading cause of maternal death in developing countries and result from problems during the immediate after birth of the neonate. Postpartum Hemorrhage is unpredictable and rapid cause of maternal death worldwide. Seventy to ninety percent of immediate Postpartum Hemorrhage is attributed to uterine atony.
Objective: To determine the magnitude, risk factors and management outcome of Postpartum Hemorrhage at Catholic Maternity Hospital, 2014/15
Method: Hospital based case control study design was used to include 3,400 mothers who gave birth during the study period. Data was collected using data collection checklists from logbook and patient folder by trained data collectors. The collected data was cleaned and entered and analyzed using SPSS Version 22 computer software. The results were presented by tables, diagrams, charts and text as appropriate.
Result: About 93.6% of mothers were gave birth at the health facility. The magnitude of PPH was 2.5%. Factors like age (AOR, 7.83; 95%CI: 1.78-34.57 ), parity (AOR, 0.37; 95%CI: 0.17-0.8) , place
of delivery (AOR, 39 ; 95%CI10.10-146.94:), route of delivery(AOR, 2.00; 95%CI: 0.84-4.60) and presence of antenatal and intra-partum risk factors(AOR, 2.53 ;95%CI:1.16-5.50) and (AOR, 0.20 ; 95%CI: 0.07-0.60), respectively, are associated with PPH. From the total, about 4.7% of cases were died in the courses of their treatment.
Conclusion: Majority of deliveries were done in health facility. The prevalence of PPH was 2.5%. Multiparity was the major antenatal risk factor that contributes to PPH while, prolonged labor was the major intra-natal risk factor and 4.7% of mothers who were admitted with PPH were died during the study period.
Recommendations: Risk factors for developing PPH found in this study are all preventable and urgent attention should given for improving the quality of maternal health service; scaling up evidence based interventions; and measuring progress.
CHAPTER ONE
Introduction
1.1 Background of study
Globally it is estimated that half a million women die annually from cause related to pregnancy and childbirth and that half of these deaths are related to obstetrics hemorrhage [1]. In 2015, the maternal mortality ratio (MMR) –defined as the number of maternal deaths per 100 000 live births – was estimated at 216 globally. This translates into approximately 830 women dying every single day due to the complications of pregnancy and childbirth. Almost all of these deaths occurred in low-resource settings, and most could have been prevented. The WHO African Region bore the highest burden with almost two thirds of global maternal deaths occurring in the region [2].
Death as a result of pregnancy remains the chief cause of premature mortality worldwide. Every year, 536,000 women and girls die as a result of complications during pregnancy, childbirth or puerperal period. This amounts to one death every minute with an estimated quarter of these deaths occurring as a consequence of hemorrhage [3].
Postpartum hemorrhage (PPH) is a major cause of maternal morbidity and mortality worldwide. The traditional definition of PPH used in most textbooks is sequence of hemorrhage (World Health Organization, excessive bleeding from the genital tract after delivery of a child and it could be primary or secondary. It is primary when there is a blood loss of 500 ml or more within the first twenty four hours after child birth and secondary if the excessive loss of blood occurred at any time after first day to 42 days of puerperium [4].
A population-based research study conducted in Bangladesh reported PPH as 6% of total maternal morbidities. [5] In a two-year longitudinal census in West Africa, the estimated postpartum morbidities through PPH were 28%. [6] A community-based survey in India has estimated that of the 560/100,000 live births PPH accounted for 35–56% of the deaths [7]. A study conducted in Pakistan revealed prevalence of PPH as 34% [8].
During the course of the MDG era the global MMR declined by 44% – equating to an average annual reduction of 2.3% between 1990 and 2015. Accelerated progress is now needed as achieving the SDG Target 3.1 will require a global annual rate of reduction of at least 7.3%.
Countries with an MMR of less than 432 deaths per 100 000 live births in 2015 will need to achieve an annual continuous rate of reduction of 7.5% [2].
1.2 Statement of the problem
In low-income countries, postpartum hemorrhage is a major cause of maternal death and arguably the most preventable. Management strategies in developed countries involve crystalloid fluid replacement, blood transfusions, and surgery. These definitive therapies are often not accessible in developing countries. Long transports from home or primary health care facilities, lack of skilled providers, and lack of intravenous fluids and/or a safe blood supply often create long delays in instituting appropriate treatment.
The lack of skilled attendants at delivery who can provide even the minimum of care, long transport times to facilities that can manage uterine atony or severe lacerations of the genital tract and unattended obstructed labor leading to a ruptured uterus conspire to elevate PPH to its position as the number one killer of women during child birth.
These structural factors are exacerbated by the prevalence of anemia, which is estimated to affect half of all pregnant women in the world, with that figure rising to 94% in Papua New Guinea, 88% in India, and 86% in Tanzania. Anemia is rarely detected or treated during pregnancy and often exacerbated by malarial and other parasitic diseases. Severe anemia may weaken uterine muscular strength or lower resistance to infectious disease, contributing to PPH and subsequent maternal mortality [10].
Addressing PPH requires a combination of approaches to expand access to skilled care and, at the same time, extend life-saving interventions along a continuum of care from community to hospital. The different settings where women deliver along this continuum require different approaches to PPH prevention and treatment. Therefore, the major objective of this study is to determine the magnitude outcome of PPH at Catholic Maternity Hospital.
1.3 General Objective
To determine the magnitude, risk factors and management outcome of PPH at Catholic Maternity Hospital, from December2014 up to November 2015.
1.4 Specific Objectives
1. To assess the magnitude of PPH at Catholic Maternity Hospital.
2. To describe the risk factors of PPH at Catholic Maternity Hospital , and
3. To identify the management outcome of PPH at Catholic Maternity Hospital.
1.5 Significance of the study
One of the sustainable development goals was to reduce maternal mortality 70 per 100,000 live births by 2030. If this is to be achieved, maternal deaths related to PPH must be significantly reduced. In support of this, health workers in developing countries need to have access to appropriate information to ensure identification of risk, early diagnosis and provision of appropriate management. The overall aim of this study is to determine the magnitude, risk factor, management and outcome of PPH. Exploring the magnitude, management and outcome of PPH will provide health care providers with information for prompt decision making in the care of women and provide a premise for improved care during pregnancy, labor and after delivery.
For more Nursing Sciences Projects Click here
===================================================================Item Type: Project Material | Size: 47 pages | Chapters: 1-5
Format: MS Word | Delivery: Within 30Mins.
===================================================================
No comments:
Post a Comment
Note: Only a member of this blog may post a comment.