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preventing and treating excessive blood loss after birth. Cochrane Database of
Systematic Reviews. February 15, 2012.
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and Health Survey 2018 Key Indicators Report. NPC and ICF; 2019.
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in northern and southern Nigeria. BMC Pregnancy Childbirth. 2019; 19: 1- 13.
Bohren MA, Lorencatto F, Coomarasamy A, et al. Formative research to design
an implementation strategy for a postpartum haemorrhage initial response
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Makinde OA, Sule A, Ayankogbe O, Boone D. Distribution of health facilities in
Nigeria: implications and options for universal health coverage. Int J Health Plann
Manage. 2018; 33: e1179- e1192.](https://image.slidesharecdn.com/thescourgeofpphinnigeria-230814182310-2ac8ddbd/85/The-scourge-of-PPH-in-Nigeria-pptx-27-320.jpg)
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- 1. The scourge of post partum haemorrhage in NIGERIA BY DR DUUM NWACHUKWU MBBS, FWACS,FMCOG, DMAS
- 2. INTRODUCTION Postpartum haemorrhage (PPH) is a major risk for mothers & newborns in Nigeria. Limited access to quality healthcare services and inadequate prenatal care contributes to the high incidence of this life- threatening condition. Postpartum haemorrhage is excessive bleeding following the birth of a baby and is a leading cause of maternal morbidity and mortality in Nigeria.
- 3. DEFINATION It is one of the leading causes of maternal mortality worldwide, including in Nigeria. Postpartum haemorrhage is defined as blood loss of more than 500 mL following a vaginal delivery or more than 1000 mL following cesarean delivery. A loss of these amounts within 24 hours of delivery is termed early or primary PPH, whereas such losses are termed late or secondary PPH if they occur 24 hours after delivery.
- 4. PROBLEMS WITH THIS DEFINITION The definition of PPH is somewhat arbitrary and problematic. Estimates of blood loss at delivery are subjective and generally inaccurate. Studies have suggested that caregivers consistently underestimate actual blood loss. Another proposal suggests using a 10% fall in hematocrit value to define PPH, but this change is dependent on the timing of the test
- 5. PROBLEMS WITH THIS DEFINITION(cont) Another consideration is the differing capacities of individual patients to cope with blood loss. A healthy woman has a 30-50% increase in blood volume in a normal singleton pregnancy and is much more tolerant of blood loss than a woman who has preexisting anaemia, an underlying cardiac condition, or a volume-contracted condition secondary to dehydration or preeclampsia. For these reasons, PPH should be diagnosed with any amount of blood loss that threatens the hemodynamic stability of the woman.
- 6. STATISTICS A study published in the Nigerian Journal of Clinical Practice in 2018 examined the incidence and risk factors of PPH among women who delivered at a tertiary hospital in North-Western Nigeria. The study reported an overall incidence rate of 6.9% for PPH among the participants. It also identified risk factors such as prolonged labour, instrumental delivery, and multiple pregnancies that increased the likelihood of experiencing PPH. Another study published in BMC Pregnancy and Childbirth in 2019 investigated the prevalence and associated factors of PPH among women who gave birth at a secondary healthcare facility in Southwestern Nigeria. The study found that out of 1,200 participants, 7.3% experienced PPH. Factors such as primiparity (being a first-time mother), prolonged labour, and episiotomy were significantly associated with an increased risk of PPH. Furthermore, a systematic review and meta-analysis published in BMC Pregnancy and Childbirth in 2020 aimed to estimate the prevalence of PPH in Nigeria based on available studies. The review included 25 studies conducted between 2000 and 2019, encompassing both facility-based and community-based settings. The findings revealed a pooled prevalence of PPH of 6.9% among women in Nigeria.
- 7. The Devastating Impacts of Postpartum Hemorrhage Mother: PPH can lead to maternal mortality, disability, depression, and an inability to breastfeed or care for her infant. Economics Impact: PPH can lead to increased healthcare costs, decreased productivity and increased poverty in affected families.
- 8. The Road to Saving Lives Skilled care during childbirth: 45% Nigeria has one of the highest maternal mortality rates in the world, but with crucial investments in healthcare infrastructure and additional medical resources, this problem can be prevented, and lives can be saved.
- 9. PPH Risk Factors Antepartum Pre-eclampsia Multiparity Multiple gestations Previous postpartum haemorrhage Previous caesarean section Intrapartum Prolonged third stage (>30 mins) Arrest of descent Episiotomy Lacerations: cervical, vaginal, perineal Assisted delivery: forceps, vacuum Augmented labour
- 10. Active management of third stage of labour (AMTSL) (AMTSL) is the key to reducing the risk of the complications As soon as the baby is delivered, put it on the mothers abdomen in skin-to-skin contact with her. Cover them with a blanket. Clamp the babys umbilical cord at two sites and cut it in between. Check the uterus for the presence of a second baby. In less than one minute, administer a uterotonic drug (a hormone-like chemical that makes the uterus contract more powerfully). Apply controlled cord traction. After delivery of the placenta, immediately start massaging the uterus. Examine the placenta to make sure it is complete and none of it has been retained in the uterus. Examine the womans vagina, perineum and external genitalia for lacerations and active bleeding.
- 11. Causes of PPH: The Four Ts Tone (70%) Trauma (20%) Tissue (10%) Thrombin (1%)
- 12. Prevention and Treatment of Postpartum Hemorrhage Preparation: Prepare for childbirth with comprehensive prenatal care and delivery with skilled birth attendants. Early detection: Using evidence-based protocols to identify women at risk can help manage delivery and prevent complications. Active management: This involves the use of prophylaxis drugs, uterotonics, and other such measures to manage delivery by a skilled healthcare provider Rescue interventions: Welcome, facility-based routine care and emergency protocols are effective interventions for PPH prevention and treatment.
- 13. PPH: Resuscitative Measures Call for help Airways, Breathing, Circulation Two large-bore IVs Oxygen Stat labs: type & cross, hb, coags Consider transfusion
- 14. Treatment Approach for PPH Catheterise bladder Uterine massage Oxytocics: OXYTOCIN, ERGOT, MISOPROSTOL, CARBITOCIN Inspect for lacerations Surgical intervention
- 15. Access to Quality Healthcare Services 1 Infrastructure & Transportation The government and private sector must invest in building and maintaining healthcare infrastructure and transportation systems to facilitate access to quality healthcare services. 2 Underserved Areas The lack of skilled birth attendants and emergency obstetric care facilities in remote areas has worsened the problem of postpartum hemorrhage in Nigeria. 3 Training & Capacity Building 鏝鏝 Continuous training and capacity building initiatives for healthcare providers can improve knowledge and skills needed to tackle postpartum hemorrhage effectively.
- 16. Comprehensive Prenatal Care Matters Importance of Regular Check- ups Regular check-ups during pregnancy can help detect potential complications and reduce the risk of postpartum hemorrhage. Nutrition & Proper Care Women need proper nutrition and prenatal care to stay healthy during pregnancy and prevent complications like postpartum hemorrhage. Antenatal Education Programs Antenatal education programs can raise awareness about the risks and warning signs of postpartum hemorrhage and empower women and their families to seek medical attention when needed.
- 17. Collaboration is Key 1 Government Intervention 鏝 The government must create policies that prioritize maternal healthcare, including funding for healthcare infrastructure, training programs, and maternal health education initiatives. 2 Community Engagement Healthcare professionals, community leaders, and traditional birth attendants must cooperate to ensure that pregnant women have access to quality healthcare and that cultural beliefs do not hamper medical intervention. 3 Training & Capacity Building Training programs for traditional birth attendants can equip them with the skills to recognize and manage postpartum hemorrhage. Healthcare professionals also need continuous training to update their knowledge and skills.
- 18. The Importance of Prompt Medical Attention Rising to the Challenge Women and families must recognize the warning signs of postpartum hemorrhage, such as excessive bleeding, and seek immediate medical attention. Overcoming Cultural Barriers Cultural beliefs and practices that hinder prompt medical intervention must be addressed through culturally sensitive education and outreach programs. Advancing Technology & Innovation Advances in technology and innovation must be leveraged to improve the diagnosis, prevention, and treatment of postpartum hemorrhage.
- 19. Improving Maternal Health Outcomes A Shared Responsibility Improving maternal health outcomes in Nigeria requires collaborative efforts between the government, healthcare professionals, community leaders, and traditional birth attendants. Access to Family Planning Services Improving access to family planning services can reduce the incidence of postpartum hemorrhage by spacing pregnancies and allowing women to plan their families. Early Pregnancy Testing & Care Early and effective pregnancy testing and care can reduce the risk of complications during childbirth and postpartum hemorrhage.
- 20. Making Progress Together 1 Data Collection & Reporting The collection and analysis of data on maternal health outcomes can help to understand and address the drivers of postpartum hemorrhage in Nigeria. 2 Advocacy & Awareness Advocacy and awareness campaigns are crucial to mobilizing resources and public support to address the problem of postpartum hemorrhage in Nigeria. 3 Research & Innovation Research and innovation can lead to new interventions and approaches that can improve maternal health outcomes and prevent postpartum hemorrhage.
- 21. Empowering Women & Families 1 Maternal Health Education Providing education and information to women and families about maternal health and postpartum hemorrhage can empower them to make informed decisions and take action when needed. 2 Maternal Healthcare Services Ensuring access to quality maternal healthcare services, including skilled birth attendants, emergency obstetric care, and postpartum follow-up care, can improve maternal health outcomes in Nigeria. 3 Community Support 鏝 Community support can be mobilized to help pregnant women access healthcare services and promote positive maternal health behaviors, leading to better outcomes for mothers and newborns.
- 22. Investment in Maternal Health Governments & Organizations 鏝 Governments, organizations, and other stakeholders must invest in maternal healthcare to achieve better health outcomes in Nigeria. Family Support 鏝 Family support is crucial to ensuring that pregnant women have access to the care and resources they need to prevent and manage postpartum hemorrhage. Advances in Healthcare Technology Advances in healthcare technology, such as telemedicine and remote monitoring, can improve access to quality maternal healthcare services, particularly in remote areas.
- 23. The Way Forward 1 Collaboration & Partnership 鏝 Collaborative partnerships between the government, healthcare professionals, traditional birth attendants, community leaders, and organizations can help to prevent postpartum hemorrhage and improve maternal health outcomes in Nigeria. 2 Empowerment & Education Empowering women and families through education and awareness can enable them to seek prompt medical attention and prevent postpartum hemorrhage. 3 Investment & Innovation Investments in infrastructure, training, and innovation can help to overcome barriers and improve maternal health outcomes in Nigeria.
- 24. CONCLUSION EDUCATION AND EMPOWERMENT OF WOMEN AND COMMUNITY
- 26. BIBLIOGRAPHY Shittu O.S, Otubu JAM, postpartum Haemorrhage in Agboola A (ED). Textbook of obstetrics and gynaecology for medical students 2nd edition. Heinemann Educational books (Nig) Plc 2006: 481-488. Koh E, Devendra K, Tan L K. B-Lynch suture for the treatment of uterine atony. Singapore Med J 2009; 50(7): 693-697. Anderson JM, Etches Duncan. Prevention a n d ma n a g eme n t o f P o st p a rt um Haemorrhage. Am Fam Physician 2007; 75: 875-882. WHO. Guidelines for the Prevention of Postpartum Haemorrhage. Geneva: World Health Organization. 2007. Ajenifuja KO, Adepiti CA, Ogunniyi SO. Postpartum Haemorrhage in a Teaching Hospital: a 5-year experience. Afr Health Sci; 2010 10: 71-74.
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