Postpartum Hemorrhage
Statistics have shown that 6-11% of maternal mortality is due to Postpartum hemorrhage. The incident can be prevented by implementing the administration of a uterotonic agent. The effect of this preventive measure in high developed countries but in low the developed countries PPH mortality still remains of high prevalence. According to studies by Haimee et.al, “A qualitative descriptive study was conducted in Gambia to evaluate the knowledge and practices of midwives in the prevention and management of PPH. Semi-structured interviews were conducted for 22 midwives. The midwives knew complications such as retained placenta and excessive blood loss and were well aware of the need to refer women to a health facility quickly. However they were not trained on the causes of excessive blood loss. The study suggests improving the skills of all health workers in primary care to reduce PPH at home childbirth.” (Haimee et.al 2016).
According to Derrick et.al The WHO defines PPH as a blood loss of 500 mL or more in the first 24 hours after delivery. A blood loss of 1,000 mL or more is considered a severe form of PPH. Other methods of clinical diagnosis are presence of rapid blood loss, a decrease in hematocrit level by 10%, changes in vital signs, and the need for emergent transfu- sion.1 Conventionally, PPH is diagnosed if blood loss is in excess of 500 mL and 1,000 mL after spontaneous and cesarean delivery, respectively. (Derrick et.al 2016).
PPH could be due to different etiological factors such uterine atony which accounts for 70% of cases, placental Previa, placenta abruption, placenta accreta, retained placenta and clots, vagina and cervica traum, inherited or acquired coagulopathies and uterine intervention. The risk factors include multiple births, prolonged labor and fetal macrosomi. However it is estimated that most women have few risk factors. The main aim of the writers of these journals is to create preventive initiatives for PPH. They proposed that since the placental expulsions is crucial, mechanical and pharmacological methods are instituted during the third stage of labor. According to Haimee et al, “A postal survey (questionnaire) was conducted in UK to ask about care during the third stage of labor, for vaginal and cesarean births. Most physicians (93%) and nurses (73%) reported the use of AMTSL in vaginal birth. The syntometrine (oxytocin and ergometrine) was the Uterotonic of choice in vaginal birth and was used by 86% of nurses, and 79% of the doctors”. (Haimee et.al, 2016)
The world health organization issued a recommendation including umbilical cord clamping and cutting, controlled cord contraction and administration of uterotonic drug to support the active management of third stage of labor. Different clinical trials in low risk patients have studied the use of prophylactic tran examic acid as an …
