PERCEIVED CAUSES OF POST PARTUM HAEMORRHAGE AMONG WOMEN OF CHILD BEARING AGE

1.1 Introduction

Postpartum haemorrhage is one of the leading causes of maternal morbidity and mortality worldwide. It occurs predominantly in developing countries due to poorly developed infrastructures and lack of skilled birth attendants. Globally, postpartum haemorrhage (PPH) remains a leading cause of maternal deaths. However in many low and middle income countries, there is scarcity of information on magnitude of and risk factors for PPH (blood loss of 500 ml or more). It is important to understand the relative contributions of different risk factors for PPH.

As a prelude to other parts of this study, this chapter will discuss the background upon which this study was initiated, the statement of problems that led to this study, the Aim and Objectives of the study. Others are Significance of the study, Scope of work, Research hypothesis and questions, Limitations of the Study and Definition of technical terms.

---

1.2 Background of Study

Globally, postpartum hemorrhage (PPH) is a leading cause of maternal mortality (Say et al., 2014). The global prevalence of PPH is 6 % (Carroli et al., 2008) and the highest burden is experienced in low-income countries (AbouZahr, 2003; Sheldon et al., 2014). The magnitude of PPH in sub-Saharan Africa is high at 10.5 % (Carroli et al., 2008). In Nigeria, PPH causes 25 % of all maternal deaths (Nationalplanningcycles, 2015). However, there is little information on the magnitude and risk factors for PPH. Common causes of PPH are uterine atony, genital tract injuries, failure of the blood coagulation system and trauma. Uterine atony is responsible for the majority (75 %) of PPH (Lutomski et al., 2012). Risk factors for PPH include; past history of PPH, multiple pregnancy, fetal macrosomia, primi-gravida, grand multi-parity, older age, preterm births, genital tract injuries, non-use of oxytocics for PPH prophylaxis, labour induction, cesarean birth and intra-uterine fetal deaths (Sheldon et al., 2014; Oberg et al., 2014; Bais et al., 2004; Sheiner et al., 2005; Sosa et al., 2009). However, majority of these studies visually estimated blood loss, a method that has considerable inaccuracy ((Al Kadri et al., 2011). The few settings differ from those in low income countries (Calvert et al., 2012). This study used a calibrated under-buttocks drape to measure blood loss that is highly correlated with the gold standard measure of photospectometry (Patel et al., 2006). Knowledge of the risk factors would inform public health interventions for PPH control. To the clinicians, risk factor identification in the antenatal and intrapartum periods may provide an opportunity for timely interventions to prevent PPH.

Increasing prevalence of PPH over the years, imbalance between resource rich and resource poor areas are probably due to the combination of increased prevalence of risk factors such as grand multiparity, lack of safe blood banking, non routine use of prophylaxis again haemorrhage, and lack of measures for drugs and surgical management of atony. It is however important to note that various authors have suggested that PPH should be diagnosed with any amount of blood loss that threatens the hemodynamic stability of the woman (Georgiou, 2009; Chelmow, 2011).

In developing countries, health systems are faced with enormous constraints that hinder the delivery of emergency obstetric care which is vital for saving the lives of women who developed PPH (Kebebush et al., 2014; Ingvil Krarup Sorbye, 2009). In most developing countries, 50% or more of deliveries are attended to by unskilled providers at home; in addition, health care facilities are often not adequately staffed or lack medicines that could address PPH (Prata et al., 2013; Mutihir et al., 2011; Naume, 2015). Consequently, many health care workers in developing countries have little or no access to basic practical information of PPH which makes it difficult to access women with any risk factors typically associated with complications that may likely develop PPH (Peltzser et al., 2009; Arulkumaran et al., 2012; WHO, 2015).

Therefore, in Nigeria where the research was carried out, the activities that was conducted is to examine the Perceived Causes of Post Partum Haemorrhage among Women of Child Bearing Age.

---

1.3 Statement of Problems

Investigation revealed that proper management of post partum haemorrhage is dependent on a number of factors which include skilled birth attendant, timely diagnoses and treatment adequate needed blood transfusion services and available and accessible health facilities (Naume et al., 2015; WHO et al., 2008). Maternal mortality ratio in Nigeria is between 23-23.8% death owe largely to post partum haemorrhage (Olowokere et al., 2013; Georgiou et al., 2009). Approximately half of all deliveries in developing countries take place without a skilled birth attendant and 70% of post partum mothers receive no post partum care in the first 6 weeks following delivery (Peltzser et al., 2009; Georgiou et al., 2009).

Several initiatives such as the Millennium Development Goals, (MDGs) and safe mother hood under taken by government to reduce maternal mortality have been unsuccessful due to people’s ignorance, and noutilization of the available facilities (Oyetunde et al., 2015; Rousseau et al., 2016). Moreso, out of the woman that finally reached and delivered at the PHC’s quite a number of them developed PPH (Lynch et al., 2006; Idris et al., 2014; Oyetunde et al., 2015).

---

1.4 Aim and Objectives of Study

The aim of the study is to examine the Perceived Causes of Post Partum Haemorrhage among Women of Child Bearing Age. In achieving this aim, the following specific objectives were laid out as follows:

1. To study the risk factors associated with postpartum haemorrhage among women of reproductive age.
2. To investigate the causes of post partum haemorrhage among women of reproductive age
3. To proffer solution to the above stated problems of Post Partum Haemorrhage among Women of reproductive age

---

1.5 Research Questions

The study came up with research questions so as to be able to ascertain the above stated objectives. The specific research questions for the study are stated below as follows:

• Is there any significant factor inhibiting the treatment of post partum haemorrhage among women of reproductive age?
• What are the causes of post partum haemorrhage among women of reproductive age?
• What are the risk factors associated with postpartum haemorrhage among women of reproductive age?

---

1.6 Research Hypothesis

In order to pursue the objective of this study, the following generalized statements have been designed to guide and aids in obtaining the result for the experiment to be conducted. For this work, the null hypothesis will be represented with H0 while the alternative hypothesis will be represented with hypothesis H1.

Hypothesis One

• H0: There is no significant factor inhibiting the treatment of post partum haemorrhage among women of reproductive age
• H1: There is a significant factor inhibiting the treatment of post partum haemorrhage among women of reproductive age

---

1.7 Significance of Study

This study will be of immense benefit to midwifery and other researchers who intend to know more on this study and can also be used by non-researchers to build more on their research work. This study contributes to knowledge and could serve as a guide for other study.

---

1.8 Scope of Study

The scope of the research is focused on the Perceived Causes of Post Partum Haemorrhage among Women of Child Bearing Age at Enugu State Primary Health Care (PHC) Centre.

---

1.9 Limitations of the Study

During the course of this study, many things militated against its completion, some of which are:

1. Time Constraint: The time frame given to accomplish this project was very short due to school academic calendar and it was carried out under pressure which made the researcher not to implement some necessary features.
2. Research material: availability of research material is a major setback to the scope of the study.
3. Frequent power failure: This made the researcher append more money on fuel to ensure sustainable power.
4. Financial Constraint: Insufficient fund tends to impede the efficiency of the researcher in sourcing for the relevant materials, literature or information and in the process of data collection (internet, questionnaire and interview).

---

1.10 Definition of Terms

PPH: It is an acronym for Postpartum hemorrhage which is an obstetric emergency.

Postpartum Confinement: It refers to a system for recovery following childbirth.