Factors Affecting the Prevention and Early Detection of Postpartum Hemorrhage Among Pregnant Women Attending Antenatal Clinic

Background to the study

World Health Organization recognized postpartum Haemorrhage (PPH) as a blood loss of 500mls or more within 24hours after birth (Onyema O.A, 2015).
Annually, about 41million cases of postpartum haemorrhage are reported globally, among these cases 127,000 died due to postpartum (World Health Organization (WHO), 2014).

According to WHO (2016), 99% of maternal deaths occurred in low and middle-income countries.

Say L, Chou D, Gemmill A & Tuncalp O (2017), highlight that more than 25% of these deaths result from postpartum bleeding, with almost 20% of all maternal deaths due to postpartum haemorrhage.

In Rwanda, 70% of maternal deaths result from direct causes, and postpartum bleeding is the leading direct cause of maternal death with 22.7% of all documented cases (Sayinzoga F, Bijlmakers L, Van Dillen J & Mivumbi V, 2016). Though there have been concerted initiatives to address maternal mortality due to PPH, the tissue remains a global burden (Finlayson K, Downe S, Vogel JP & Oladop OT, 2019).

The recent data from WHO (2019), suggest that less than 50% of all births in several low income and lower-middle income countries are assisted by trained midwives, doctors or nurses while in most high-income and uppe-middle income countries, reports demonstrate that more than 90% of all births benefit from the presence of a skilled birth attendant. Factors related to provision of substandard care were identified for 61.1% of the maternal death cases in a study on maternal death audit in Rwanda (Sayinzoga F et’al, 2016).

WHO (2019), provides recommendations for skilled health care providers and other stake holders on the effective use of uterotonics for PPH prevention among women giving birth in hospital or community settings from high-income, middle-income or low-income countries.

However, Raghavan S, Gelller S, Miller S & Goudar S (2016), affirm that routine uterotonic prophylaxis such as the use of oxytocin as a gold standard uterotonic medication for PPH prevention is not 100% effective in PPH prevention. Therefore, WHO is urging different partners to review their respective national health policies and protocols on PPH prevention to reflect quality of care for women which involves timely and appropriate care to achieve desired outcome consistent with professional knowledge and considering the preferences and aspirations of pregnant women and their families (WHO, 2016).

In addition, Prata N, Bell S & Weidert K. (2017),highlight the need for every country to develop its own policies and programs specific to local context and incorporating a variety of approaches to prevent and address PPH challenges. Different ways to prevent PPH fall under the widely used Essential Public Health Operations (EPHO) that different country with the leadership of WHO can adapt and work on together, to assess and plan for sustainable public health services and capacities (WHO, 2018). The EPHO – five, focuses on prevention of disease through actions taken across the three levels of disease prevention are within the roles and responsibilities of health care providers in Primary health care, hospitals and community service environments (WHO, 2018).
There is cause to consider that the investigation of factors affecting the early detection and prevention of postpartum haemorrhage among pregnant women from different perspectives is crucial to enhance quality of care during childbearing period. Striking factors at different levels of service delivery have been found to be critical in shaping participant’s experience for the implementation of obstetric haemorrhage initiative in Florida (Vamos CA., Thompson EL, Cantor AS, Detman L, Bronson E, & Phelps A, 2017).

Prevention of anaemia in pregnancy, appropriate management of first and second stages of labour, effective physiologic or active management of the third stage of labour with uterotonic agents may prevent complications of postpartum haemorrhage (Niflot LT, 2017).
Delay of women to seek maternity care, delay to arrive in health care facilities and delay in receiving care from skilled health care professionals play a role in high maternal mortality rate and serious morbidity in Nigeria (Onyema O.A,2015).

Woiski MD & Scheepers HC (2015) demonstrated that the main obstacle for high quality postpartum haemorrhage care identified by patients was the lack of information given by the professionals to the patient and partner before, during and after the postpartum haemorrhage event, while health care providers expressed hindering factors such as lack of clarity of the guidelines, lack of knowledge and poor communication within teams.
Therefore, to improve the quality of care provided to women for the prevention of postpartum haemorrhage, an in-depth analysis from different perspectives identifying influencing factors for the delivery of high quality postpartum haemorrhage care will provide necessary information for implementing a strategy to improve care.

This study aims to explore factors affecting the prevention and early detection of postpartum haemorrhage as perceived by pregnant women attending antenatal clinic at Comprehensive Primary Health Care Centre Kwandare Commnuity Of Lafia.