CHAPTER ONE

INTRODUCTION

1.0 Background Of The Study

The World Health Organization (WHO) defines post-partum hemorrhage as 500ml of blood loss after vaginal birth and 1000ml of blood loss in case of cesarean births.  The bleeding that occurs during the first 24hours after delivery is called primary hemorrhage.

When this occurs after 24hours of birth until six weeks it is called secondary postpartum hemorrhage (WHO, 2012).

PPH is the leading cause of maternal mortality. Although maternal mortality rates have declined greatly in the developed world, PPH remains a leading cause of mortality elsewhere (Pel et al, 2004).

Globally, 35% of maternal deaths are associated with PPH (WHO, 2009).

The proportions of maternal deaths attributed to PPH vary considerably between developed and developing countries suggesting death from PPH are preventable.  Interventions to prevent PPH in the developing countries are therefore pivotal in the global effort to achieve by 2015 the millennium development goal (MDG) of reducing maternal mortality ratio by three quarters (Khanks, 2006).

PPH occur in up to 18% of birth and even with appropriate management, 3% of per vaginal deliveries will result in severe PPH (Anderson et al., 2008)

PPH is the most common cause of perinatal deaths in the developed world and

However, studies have shown the trend of increased incidence of PPH as a major cause of severe maternal mortality (near-miss) in developed countries, such as Australia Canada, the United Kingdom, and the United States (Alexander, 2015)

PPH is one of the most serious complications in obstetrics and the woman’s life depends on the nurse/midwife’s prompt intelligent action (Guire, 2011).

Causes of PPH are as follows;

• Uterine atony (70%)
• Trauma (20%)
• Retained tissue (10%)
• Coagulopathy (1%) (WHO, 2009).

Also, statistics from Pan African Medical Journal (2015) show that 550,000 women die yearly from pregnancy-related causes. Fifty percent (50%) of world estimates of maternal death occur in sub-Saharan Africa alone.

A case-control study carried out from 2006-2010 shows that PPH causes 25% of maternal deaths in Cameroon. In Cameroon maternal ratio has shown an increase from 430 per 100000 live births in 1991 to 430 in 1998, 669 in 2004, and 782 in 2011 (Marrere, 2008). Hence maternal mortality in Cameroon remains a paradox.

1.2. Statement Of The Problem

More than half a million women die worldwide during pregnancy and birth each year, 99% of them in developing countries and these women usually bleed to death. These deaths are distributed as follows; 24% during pregnancy, 16% during delivery and 60% percent postpartum (WHO, 2012).

In Africa and Asia where most maternal deaths occur PPH account for more than 30% of all maternal deaths (Carrol, 2008).

In Uganda, a prospective cohort study was conducted at six health facilities between2013– 2014. This study registered 1188 women with an overall incidence of postpartum hemorrhage of about 9.0%.

A prospective cohort study was conducted in Guinea Bissau 2000 – 2004 that followed almost 10.000 women of reproductive age. This study registered 112 maternal mortality rates of 800 deaths per 100.000 live births.

The total fatality rate was 6.5% implying that one woman in 19 suffered a pregnancy-related death, 42% of the deaths were from PPH (Aleen et The situation in Cameroon is characterized by a mortality rate of 669 per 100.000 live births in 2004, an increase from an estimated 484 maternal deaths per 100.000 live births in 1998 (Halle, 2005)

A descriptive and historical cohort study carried out from 2003 -2005 in the Regional Hospital Maroua had the following maternal mortality rate; out of 1492 total live birth in 2003, 21 maternal deaths occur making MMR at 140.75%; in 2004 out of 1744 total live birth, 19 maternal deaths occur giving 1089.6% as MMR and out of 1735 live birth in 2005, 23 maternal deaths occur giving a total of 1266.3% MMR.

The majority of the pregnancy-related deaths 73% were the direct result of complications during pregnancy (Collin et al, 2006)

The situation in Regional hospital Bamenda from2011-2016 is as follows; 2011 was 59, 2012 was 65, 2013 was 58, 2014, 2015, 2016 was 26.

However, the reality of the prevention of postpartum hemorrhage (PPH) is much more complex involving the ability to evaluate, the right knowledge, and effective work by a caregiver. It is therefore expedient to assess the level of knowledge and strategies used in the prevention of postpartum hemorrhage by nurses and midwives in the Regional Hospital Bamenda.

1.3. Research Question

What are the knowledge and the preventive practical measures of nurses and midwives in the Bamenda Regional Hospital on postpartum hemorrhage?

1.4. Research Objectives

1.4.1. General Objective

To assess the knowledge of Nurses/Midwives in the Bamenda Regional Hospital in the prevention of postpartum hemorrhage.

1.4.2. Specific objectives

1. To determine the knowledge of nurses and midwives on PPH.
2. To find out their practical measures in the prevention of PPH.
3. To find the problems or challenges they face in the practice of the preventive measures

1.5. Hypothesis

Nurses and midwives who are knowledgeable and practice preventive measures of PPH reduce the risk of PPH in clients than nurses/midwives who have inadequate knowledge in the preventive practices of PPH in clients.

1.6. Significance Of The Study

The results obtained from this study will help to advance the understanding of nurses and midwives on the prevention of post-partum hemorrhage. and provide the ministry of health, future researchers, and social welfare with the necessary information necessary to assess AMTSL practice and identify major barriers to its use. In other to reduce obstetric emergencies due to PPH and remarkably reduce PPH-related maternal death.

1.7. Scope And Delimitation

Those included in this study were all graded Nurses and midwives working in the Bamenda Regional Hospital irrespective of their age, sex, educational level, and units of practice.