KNOWLEDGE AND PRACTICES OF NURSES AND MIDWIVES ON THE PREVENTION AND MANAGEMENT OF POSTPARTUM HEMORRHAGE WITHIN THE MUEA HEALTH AREA

Abstract

Postpartum hemorrhage (PPH) remains the leading cause of death amongst women all over the world. PPH accounts for 30% of maternal death, one of the complications of the third and fourth stage of labor was discovered to be PPH. PPH is preventable however, with 275000 births in sub-Sahara Africa, 1.2% of women suffer from PPH.

The main objective of this study was to investigate nurses and midwives’ knowledge and practices in the prevention and management of postpartum hemorrhage at the Muea Health Center Buea, Cameroon. A descriptive cross- sectional study design was used (sampling technique) was used to select 60 (100%) participants from the study area. Data was collected using a structured questionnaire.

The data was analyzed using SPSS version 20.  Results showed that majority 50 (90%) were aware of PPH, 30 (50%) of the respondent cited blood loss of more than 500mls following vaginal delivery. With respect to the practices of nurses and midwives in the prevention of PPH, the present study shows that majority 50 (90%) were aware on the prevention of PPH as (75 %) of participants said prophylactic injection of oxytocin prevents postpartum hemorrhage.

Based on the management techniques used by nurses and midwives in the prevention of PPH, majority of the respondents (80%) were aware on the management of postpartum hemorrhage as (45%) of the participants said administration of uterotonics immediately after the birth of the baby can manage postpartum hemorrhage.

Based on the result obtained, it is concluded that, nurses and midwives had adequate knowledge on PPH, they as well had good practices on the prevention and management technique with regards to PPH. We suggest that health care should focus and do more implement measures in preventing postpartum hemorrhage which will help in combating the consequences that could result from it.

CHAPTER ONE
INTRODUCTION

1.1 Background of the study

Postpartum hemorrhage (PPH) remains the leading cause of death amongst women all over the world. PPH accounts for 30% of maternal death, one of the complication of the third and fourth stage of labor was discovered to be PPH (Getus, wogie, cimino, 2018). PPH is preventable however, with 275000 birth in sub-Sahara Africa, 1.2% of women suffer from PPH (GE et al, 2018). It was indicated that poor management skills was amongst the cause (TI Ramavhoya, 2021). Postpartum hemorrhage (PPH) is severe bleeding after giving birth which is a serious and dangerous condition.

PPH usually occurs within 24 hours of childbirth, but it can happen up to 12 weeks postpartum. When the bleeding is caught early and treated quickly, it leads to more successful outcomes. WHO defines postpartum hemorrhage as blood loss of more than 500ml following vagina delivery or more than 1000ml following cesarean delivery and according to (Samuel Ojong, 2015) a loss of blood that cause hemodynamic instability.

Postpartum hemorrhage(PPH) accounts for 35 percent of all maternal deaths .14 million women around the world suffer from PPH every year translating to 26 women per minute all women who carry a pregnancy beyond 20weeks gestation are at risk of postpartum hemorrhage although maternal mortality rate has decline greatly in developed world? PPH remains a leading cause of maternal mortality elsewhere (Hanan, 2014).

Postpartum hemorrhage is when the total blood loss is greater than 32 fluid ounces after delivery, regardless of whether it’s a vaginal delivery or a Cesarean section, or C-section, or when bleeding is severe enough to cause symptoms of too much blood loss or a significant change in heart rate or blood pressure. PPH is one of the most alarming and serious emergencies which health professionals may face at the health centers and their prompt and competent management will be crucial in controlling blood loss and reducing the risk of maternal morbidity (A N, 2015).

The majority of death due to postpartum hemorrhage is caused by uterine atony (a condition when the uterine muscles failed to contract and legate uterine blood vessels after delivery of the placenta). Most of the time, maternal mortality and morbidity due to postpartum hemorrhage (PPH) takes place within 24hrs after delivery within the time frame of primary postpartum hemorrhage (G E et al, 2018).  Sub-Sahara Africa alone accounting for roughly 66% (20100).

The overall mortality death in developing regions is 239 per 100,000 live birth with just 12 per 100,000 live births which is much higher than that of developed regions, where it is just 12 per 100,000 live births (Ge et al, 2018). several countries have maternal mortality rates in excess of 1000women per 100000 live births in developing, and the world health organization statistics estimated that 60percent of maternal death in developing countries are due to postpartum hemorrhage accounting for more than 100000 maternal deaths per year While PPH seems to be most devastating in developing countries, recent studies has shown increasing incidence of PPH.

In Cameroon, maternal mortality ratio related to PPH has shown an increase from 782death per 100000live birth in 2011 (WHO). The main cause of maternal death was hemorrhage (38percent) with primary postpartum hemorrhage being the leading cause of death accounting for 4.1 percentage of cases (NH et al, 2016). Studies conducted in the general hospital and the Yaoundé central teaching hospital in 2013 reported prevalence of primary PPH of 1.6 percent and 4 percent respectively.

Recently, the incidence of primary postpartum hemorrhage at the Yaoundé central teaching hospital was reported at 13.9percent in 2014. This indicate that the prevalence of primary postpartum hemorrhage has significantly increased over the past years hence, maternal mortality in Cameroon remains reason why it is a necessity to investigate the knowledge and practices of nurses and midwives in the prevention and management of postpartum hemorrhage.

1.2 Problem Statement

WHO estimated that 25% of maternal mortality is caused by PPH (Google Scholar). Postpartum hemorrhage is the leading cause of maternal mortality worldwide, accounting for 34% of maternal death in sub Saharan Africa (WHO, 2017). In Cameroon, the maternal mortality rate has increased over 789 deaths/100,000 live births in 2014 (T Pierre-Marie. 2015).

The main cause of maternal death was hemorrhage (38%) with primary postpartum hemorrhage being the leading cause of death accounting for 4.1% of cases and to reduce the problems of maternal mortality is not easy, it has become a problem for the health professional and the nation.

The services available for the proper management of postpartum hemorrhage are fragmented, poorly financed and have inadequate infrastructure and staffing, making it difficult to provide more than the most basic health service to the majority of the population. It is a pressing need to investigate the knowledge and practices of nurses and midwives in the prevention and proper management of this crucial leading cause of postpartum hemorrhage.

1.3 Research Question

What is the knowledge of nurses and midwives in the prevention and management of postpartum hemorrhage?
What are the practices of Nurses and Midwives in the prevention and management of postpartum hemorrhage?
What are the management techniques used by Nurses and Midwives in the prevention of postpartum hemorrhage?