Abstract

Postpartum haemorrhage is the blood loss of < 500ml or more from the vagina tract after delivery of a baby. According to WHO, (1989), postpartum contributes significantly to maternal mortality and it is the leading cause of maternal deaths globally contributing to one quarter of the deaths annually.

This clinical study of a 26 year old female diagnosed with postpartum haemorrhage at the CMA (Centre Medical D”arrondissement ah was hospitalised for four days (12th -15th march 2019). The study aimed to review literature on Postpartum haemorrhage, to present statistics on postpartum haemorrhage, in the CMA and to care for a 26 year old female diagnosed with PPH.

It was carried at the CMA Mutengene .The patient’s subjective and objective data was obtained through health history taking and four techniques of physical assessment respectively and the Nursing Care Plan was used to care for the patient. Ethical clearance to conduct study was obtained from Biaka University Institute Buea. The patient’s status was carefully monitored until discharge after 4 days of hospitalisation.

One of the millennium development goals set by the United Nations is to reduce the maternal mortality by three quarters by 2015. The achievement of this goals must be focus on the understanding the dynamics of them causes of maternal mortality and removing such causes.

This work highlights currently the risk factors and preventive measures for managing Postpartum haemorrhage, view their prevalence of PPH , pathophysiology, signand symptoms, clinical examinations, complications and adverse outcomes of PPH  and the nursing responsibilities for women anticipating with postpartum haemorrhage.

CHAPTER ONE

INTRODUCTION

1.0 General Introduction

This chapter focuses on the nursing management of postpartum haemorrhage which is the leading cause of maternal deaths. Maternal mortality today poses a great challenge especially less developed countries in the world.One of the factors that account for a maternal mortality in the world is postpartum haemorrhage (Mowafi, 2003).

Each year an estimated 14million with cases of postpartum haemorrhage suffer every year.The vast majority of these deaths occur in low and middle- income countries.

Recent studies have shown increasing incidence of postpartum haemorrhage in developed countries as well (Jonathan, 2012).

Royal college of Obstetricians and Gynaecologists also endorses a definition based on 500ml or more. However, in the absence of shock, they recommend only “readiness for resuscitation” at blood loss. If major PPH occurs, ablood loss of 1000ml or more, they recommend a full protocol of measures to achieve resuscitation and haemostasis. Similarly, American Congress of Obstetricians and Gynaecologists endorses a definition of 1000ml or more or any loss with symptoms or signs of hypovolemia. (Blum J,2010).

A WHO technical working group in 1989 endorses a definition of a blood loss of 500ml or more from the genital tract after delivery of a baby. Ragan F, 2006. They accepted that this was an “arbitrary figure” and not ways and not ways of great clinical significance, however, they decided against a greater volume as the measurement of collected blood frequently and significantly underestimates the actual blood loss. Patel A, 2006.

PPH is the consequences of several different pathologies that can occur in isolation or combination. Uterine atony, genital tract, trauma, retained placenta tissue and coagulation abnormalities .Stafford, 2008. In severe cases postpartum, often pathologies co-exist with tractable haemorrhage often leading to coagulopathy. (WHO,1990). Uterine atony is regarded as the most cause of PPH .It occurs when inadequate myometrial tone results in unchecked blood flow to the placenta bed.

1.1 Background to the Study

Postpartum haemorrhage which is the leading cause of maternal mortality and morbidity worldwide and accounts for nearly one quarter of all maternal pregnancy related deaths. (Berg CJ, 2005). Multiple studies have suggested that maternal deaths associated with postpartum haemorrhage could be prevented by prompt recognition and more timely aggressive treatment.

The most common aetiology of PPH which occurs in about 80% of case. Atony may be related to over distension of the uterus, infections, and placental abnormalities. (Miller S, 2009). Though the majority of women who developed PPH have no identifiable risk factor, but some clinical factors associated with uterine atony include high parity, Prolonged labour.

The overall prevalence of PPH worldwide can be estimated to be 6-11% of births with substantial variations across regions (Calvert C Thomas, 2012). Prevalence ranges from assessment method by objective measurement of blood loss. In the United States, Canada. Australia since 1990s, the increase of PPH has increased in those high resource countries and studies found that the incidence of PPH increased by 26% from 1994 to 2006 and factors underlining the increase remains unclear ((Rath, 2010).

Globally PPH is responsible for 25% of all delivery associated deaths and this figure is high as 60% in some other countries (Mininoetal, 2007). International initiatives to improve outcomes have invested in training birth attendants and nurse midwives on the active management of third stage of labour.

Nigeria’s mortality rate is one of the highest in the world  (Bankole ,2009) ,for every 100000 live births there is 1100 maternal deaths .Although the government  has developed policies to reduce maternal deaths , the implementation of these policies has been ineffective due to low spending on health care in Nigeria(Bankole,2009).

In reaction to these high death rates, the United Nations established Millennium Development Goals (MDG) in the year 2012 (WHO, 2012). One of the eight goals focuses on decreasing death toll from 526,300 1980 to 342,900 in 2015. Despite this successful drop in PPH mortality rate, only 23 countries improved, the mortality rate for Nigeria and surrounding sub Saharan countries are not improving (Brighton et al., 2012)

Over the last 15 years, maternal mortality has declined in most part of the world, although not as much as anticipated when the Millennium Development Goals were agreed to in 2000. The maternal mortality burden also remains substantial, especially in comparison mortality. Although estimates vary (Graham et al, 2016) the rate of PPH from 1.5% in 1999 to 4.1% in 2009, and the rate of atonic PPH rose from 1% in 1999 to 3.4% in 2009. The risk of total PPH with mobility adherent placenta was marked higher (Bacling Smith, 2009).

1.2 Objectives Of The Case Study

1.2.1 General Objective

Using the nursing process and all its forceps in managing a patient with postpartum haemorrhage in cubing the risk of maternal mortality rate at C.M.A (Centre MedicaleD”arrondisement) Mutengene

1.2.2 Specific Objectives

1. To identify the general health problem of a mother suffering from postpartum haemorrhage at C.M.A(centre medicaled”arrondissement) Mutengene
2. To identify the needs of a patient presenting with postpartum haemorrhage at C.M.A (centre medicaledӇrrondissement) Mutengene
3. To help patient promote health and medical understanding of such condition through the application of nursing skills by educating patient of various ways to prevent Postpartum haemorrhage in C.M.A (centre medicaled”arrondissement) Mutengene.