Abstract

The purpose of the study was to investigate nurse’s knowledge on the challenges faced on the management of post-partum hemorrhage in the Buea Regional Hospital. The study is a cross sectional descriptive design that was carried out at the Buea Regional Hospital with a sample size of 50 nurses from October 2022 to February 2023. Data was analysed using Microsoft excel 2010 and data was presented in bar chart, pie chart and tables.

Based on my objectives one and two, I concluded that respondents have knowledge on post-partum hemorrhage since 78% and 100% respectively could define post-partum hemorrhage correctly and its managements of PPH. Based on my third objective, 83.3% of my respondents faced challenges in the management of post-partum hemorrhage.

CHAPTER ONE

INTRODUCTION

1.1 Background

During the 18th century, midwives was well established but postpartum hemorrhage was not recognize as a specific obstetrical disorder ( Mc GrewRe 1885),by the end of the century, medical professionals began to understand the anatomy of the uterus and physiological changes that can take place during labor (Gasner A metal 2022) .

The introduction of forceps in child birth also took place at this time, by then medical obstetric was only control by women midwives (bynum wF 1993),the addition of males midwives is historically a significant change to the profession of obstetrics, medical men began to train in area of childbirth and believe with their advanced knowledge in anatomy that complications following delivery as well as postpartum hemorrhage could be properly prevented and manage (Aziatol metal 2018.

In the  19th century , physicians expected that obstetric will continue to grow so as to reduce maternal mortality due to hemorrhage following delivery (postpartum hemorrhage),but the opposite happened, obstetric entered a stage of stagnation which last until about 1880s (Gelis 1991) which dramatically increase  postpartum hemorrhage due to lack of skills and knowledge on delivery, this made it nearly impossible to pursue and education in midwifery  and obstetric was pushed to the side (bynum wF et al., 1993) .

By then mortality rate in lying hospital was unacceptably high and became an area of public concern and much of these maternal deaths where due to postpartum hemorrhage ( Caplan CE 1995). This is exemplified by statistic collected by the WHO which show that 99 % of the world ‘s half million annual maternal death occur in developing countries (WHO 2007) , lifetimes risk of maternal death is as  high as one in six for women living in the world’s poorest nations.

Postpartum hemorrhage (PPH) is defined as the blood loss of more than 500 milliliters following a vaginal delivery or more than 1000 ml following caesarian section (WHo2018).

PPH also can be defined as any amount of vaginal bleeding following delivery that causes vital sign derangement or loss of 10% hemoglobin from the baseline (palmsten k Achytes ED et al). PPH can be caused primarily by atony uterus, retained tissue, genital tract tear, coagulation problem, and uterine rupture(American college of obstetrician and gynecologists 2018).

PPH is more likely to occur in women with predisposing factors such as maternal obesity, macrosomia baby pregnancy induced hypertension (Tatsuya etal,2019), it is  characterize by signs and symptoms like hypovolemia, reduce hemotocrit level (Kuma N etal,2016) therefore measure of diagnosis of PPH include quantification of blood loss that is mostly done by counting the number of pads wait (Awhonn,2015), further more PPH can be prevent by practicing appropriate management of third stage of labor (AMTSL)(Begley CM etal,2015),if the third stage of labor is not properly follow up it can lead to complications such as hypovolemic shock ( Fullerton etal ,2013).

Despite there is a decline in maternal mortality, the rate is as high as 412 per 100,000 live births (EDHS 2016).World health organization reported that hemorrhage is the first leading case of maternal mortality globally (say L Chou, Miller) . Over the past year, women of reproductive age die annually from complications associated with childbirth and post-partum hemorrhage contribute to 115000 maternal deaths in low income counties (Herrick T, etal, 2017).

Globally the prevalence of PPH is estimated to be 60% and the highest burden is experience by women worldwide (Ononges, étal, 2016). Approximately one out of every thousand females that goes through labour and delivery experience PPH in low income countries (Tort JB étal, 2013). A  systemic review on the epidemiology of PPH revealed a prevalence rate of 6.37 % in North America, follows by 2.55% Asia and 6.38% in Europe (Gerrdich etal,2008).In the society of obstetrician s and Gynecologist of Parkistan country (SOGP) wide hospital study show  that 21.2% of maternal deaths were due to PPH.

In Africa the overall prevalence rate is estimated to be 34 % which includes Nigeria prevalence of 1.13% ( upchiggozie ozo etal 2018) , and prevalence in Cameron that is 23.63% ( HalleEkane G etal, 2018). Maternal mortality rate have increased from 669 deaths in 2004 to 789 deaths in 2014 per 100,000 live births due to PPH and secondary to uterine atony (Fotso etal ,1999). Still in Cameron but precisely in south west region in Fako Division the PPH prevalence rate is estimated to 13.15% (theophile Ndjamen, etal, 2021).

1.2 Problem Statement

Despite the progress made in the management of PPH, it remains an important factor in maternal morbidity and mortality, in both developing and developed countries (INS Etal 2004). Begley emphasize that adequate management of third stage of labor ((AMSTEL and uterine massage which contribute to reduce significant Postpartum complications (Begley CM, ét al, 2015), because inadequate management of women during labor can lead to increase in maternal mortality.

The overall prevalence is estimated to be 60% with high burden in low income countries, (Ononges, etal, 2010). systemic review conducted by WHO found that PPH is the leading cause of maternal mortality in Africa accounting to up of half of the total number of deaths (WHO 2005).

During my various internship in the hospital I noticed that majority of women bleed excessively after delivery. Therefore the nursing role in the Prevention of postpartum hemorrhage is needed to eliminate PPH as the leading cause of maternal mortality (WHO and UNICEF, 2015).it is in this light that the research took interest in investigating nurse’s knowledge on the challenges face in the Prevention of PPH

1.3.1 Objective of the Study

1.3.1 General Objectives

This study aimed at investigating challenges faced by nurse’s in the prevention of PPH   in Buea Regional Hospital

1.3.2 Specific Objectives

1. To assess nurse’s knowledge of PPH Buea Regional Hospital.
2. To determine the management of PPH among nurses in Buea Regional Hospital.
3. To identify challenges faced during the management of PPH among nurses in Buea Regional Hospital.

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