scholarly journals An Exploration of Midwives’ Experiences of Reducing Maternal Morbidity and Mortality From Postpartum Haemorrhage (PPH) in Rural Communities in Eastern Nigeria.

2021 ◽  
Author(s):  
Felicity Agwu Kalu ◽  
Joan Nkechi Chukwurah
Keyword(s):  
Health Care ◽  
Rural Communities ◽  
Rural Health ◽  
Rural Health Care ◽  
Maternal Morbidity ◽  
Postpartum Haemorrhage ◽  
Morbidity And Mortality ◽  
Active Management ◽  
Team Approach ◽  
Maternal Morbidity And Mortality

Abstract Background Postpartum haemorrhage (PPH) is one of the major complications of childbirth which results in maternal morbidity and mortality especially in low and middle-income countries like Nigeria. Midwives play a vital role in preventing and managing PPH in Nigerian rural communities. The aim of this study is to understand the experiences of midwives in rural maternity care settings in order to provide appropriate support and improve practice. Methods An exploratory qualitative study of a purposive sample of 15 practicing midwives was carried out using semi-structured interviews from November 2018 to February 2019. Data were transcribed verbatim and analyzed using content analysis. Results Four themes were identified; intervention for preventing PPH, approaches to managing PPH, challenges of preventing and managing PPH, and ways of supporting midwives to overcome the challenges of preventing and managing PPH in rural health care settings. Midwives employed various strategies, such as antenatal education, diagnosis, and treatment of anaemia to prevent PPH. Their understanding of the condition as a life-threatening condition enabled the midwives to provide holistic and effective management that sometimes involved multidisciplinary team approach. However, inadequate resources and delay in seeking health care services militate against their efforts. The midwives also identified the need for continuing education and training as means of enhancing their standard of care. Conclusion These midwives in Nigerian rural health care setting engage in preventive practices and active management of PPH though not without barriers, such as inadequate resources. There is need for the midwives in rural areas to have cultural competence, be provided with adequate resources and participate in ongoing education to be more effective.

Active management of the third stageof labor for the prevention of postpartum haemorrhage

2014 ◽  
Vol 63 (2) ◽  
pp. 22-27
Author(s):  
Natalya Vladimirovna Artymuk ◽  
Mariya Nikolayevna Surina ◽  
Tatyana Yuryevna Marochko ◽  
Natalya Borisovna Kolesnikova
Keyword(s):  
Blood Loss ◽  
Maternal Morbidity ◽  
Postpartum Haemorrhage ◽  
Active Management ◽  
Controlled Study ◽  
The Third ◽  
Randomized Controlled ◽  
Obstetric Haemorrhage ◽  
Maternal Morbidity And Mortality ◽  
Perinatal Center

Obstetric haemorrhage remains a main cause of maternal morbidity and mortality. A hospital-based, individually randomized controlled study was proposed. 1095 women delivering vaginally in Kemerovo Perinatal Center were examined. Absence of controlled cord tractions hasn’t significant effect on amount of blood loss in the III stage, and frequency of PPH, in usage of additional uterotonics, postpartum hemoglobin levels, frequency of manual removal of placenta.

Uterine laceration – a rare case of postpartum hemoperitoneum

2021 ◽  
Vol 86 (5) ◽  
pp. 335-338
Author(s):  
Carlos Silva Macedo ◽  
◽  
Cristina Pestana Domingos ◽  
Rita Leiria Gomes ◽  
Zeferino Pina ◽  
...  
Keyword(s):  
Key Words ◽  
Uterine Rupture ◽  
Maternal Morbidity ◽  
Rare Case ◽  
Postpartum Haemorrhage ◽  
Morbidity And Mortality ◽  
Early Postpartum ◽  
Maternal Morbidity And Mortality

Postpartum haemorrhage is a major cause of maternal morbidity and mortality worldwide. Early dia gnosis and treatment are essential to prevent sequelae or even death. We describe a rare case of early postpartum haemorrhage with hemoperitoneum due to a laceration of the uterine serosa with exposure of a uterine vessel solved by laparotomy. Key words: postpartum haemorrhage – uterine rupture – parturition

scholarly journals Manual Removal of the Placenta after Vaginal Delivery: An Unsolved Problem in Obstetrics

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Fiona Urner ◽  
Roland Zimmermann ◽  
Alexander Krafft
Keyword(s):  
Maternal Morbidity ◽  
Placenta Previa ◽  
Morbidity And Mortality ◽  
Active Management ◽  
Retained Placenta ◽  
Manual Removal ◽  
The Third ◽  
Third Stage Of Labor ◽  
Third Stage ◽  
Maternal Morbidity And Mortality

The third stage of labor is associated with considerable maternal morbidity and mortality. The major complication is postpartum hemorrhage (PPH), which is the leading cause of maternal morbidity and mortality worldwide. Whereas in the event of PPH due to atony of the uterus there exist numerous treatment guidelines; for the management of retained placenta the general consensus is more difficult to establish. Active management of the third stage of labour is generally accepted as standard of care as already its duration is contributing to the risk of PPH. Despite scant evidence it is commonly advised that if the placenta has not been expelled 30 minutes after delivery, manual removal of the placenta should be carried out under anaesthesia. Pathologic adhesion of the placenta in the low risk situation usually is diagnosed at the time of delivery; therefore a pre- or intrapartum screening opportunity for placenta accreta would be desirable. But diagnosis of abnormalities of placentation other than placenta previa remains a challenge. Nevertheless the use of ultrasound and doppler sonography might be helpful in the third stage of labor. An improvement might be the implementation of standardized operating procedures for retained placenta which could contribute to a reduction of maternal morbidity.

scholarly journals Insights for rural health care provider retention : a quantitative survey analysis

2021 ◽  
Author(s):  
◽  
Maria Kuhns
Keyword(s):  
Health Care ◽  
Rural Communities ◽  
Rural Health ◽  
Health Care Provider ◽  
Health Care Providers ◽  
Care Provider ◽  
Rural Health Care ◽  
Care Providers ◽  
The Impact

Due to rural health disparities and an uneven distribution of health providers across the rural urban continuum, retaining the existing rural health care provider workforce may be an important strategy to maintain existing rural health care provision. While a large body of literature addresses how to recruit health care providers to rural areas, less is known about how to retain these providers. Even less literature has focused on the role of rural communities in health care provider retention. In this thesis, I examine the role of provider background and familial characteristics, workplace characteristics, and community characteristics that may impact a provider's likelihood to consider leaving a rural community. I use data from a survey of over 900 rural health care providers across nine states and a probit model to estimate the impact of these characteristics on a provider's propensity to consider leaving. I find that establishing social ties and integrating within the community through volunteering reduces providers' likelihood to consider leaving by 10 percent. Additionally, providers who engage in entrepreneurship by investing in part or all of their practice are 12 percent less likely to consider leaving, all else being equal. I also find that having unacceptable on-call responsibilities increases a provider's likelihood to consider leaving by 17 percent. This thesis contributes to the existing literature by estimating the effects of work-life balance, entrepreneurship, and the role of family and personal integration on provider retention. Furthermore, it emphasizes the role of communities in provider retention. These results offer insights to rural communities and decision-makers seeking to identify how to maintain their existing rural health care workforce.

scholarly journals Management of postpartum haemorrhage

F1000Research ◽  
2016 ◽  
Vol 5 ◽  
pp. 1514 ◽  
Author(s):  
Marie Pierre Bonnet ◽  
Dan Benhamou
Keyword(s):  
Tranexamic Acid ◽  
Maternal Morbidity ◽  
Postpartum Haemorrhage ◽  
Morbidity And Mortality ◽  
Trauma Patients ◽  
Transfusion Strategy ◽  
Recent Advances ◽  
Maternal Morbidity And Mortality

Postpartum Haemorrhage (PPH) is a major cause of maternal morbidity and mortality. Treatment of acquired coagulopathy observed in severe PPH is an important part of PPH management, but is mainly based on literature in trauma patients, and data thus should be interpreted with caution. This review describes recent advances in transfusion strategy and in the use of tranexamic acid and fibrinogen concentrates in women with PPH.

scholarly journals Uterine preservation with Cho suture in localized multifocal atonicity of uterus with failed medical management and uterine tamponade

2020 ◽  
Vol 9 (11) ◽  
pp. 4698
Author(s):  
Shailesh K. Makwana ◽  
Sonal C. Halpati ◽  
Chirag Patel
Keyword(s):  
Medical Management ◽  
Maternal Morbidity ◽  
Postpartum Haemorrhage ◽  
Morbidity And Mortality ◽  
Uterine Preservation ◽  
Maternal Morbidity And Mortality ◽  
Uterine Compression Suture ◽  
Compression Suture ◽  
The Common ◽  
D Dimer

Postpartum haemorrhage (PPH) is a major cause of maternal morbidity and mortality, and one of the common obstetrical emergencies. Quite commonly, it occurs in patients where PPH is not expected. Management has to be swift and precise according to the steps and the response initiated by the uterine musculature during the management. In our patient, we had a localized multifocal atony of the uterus, at points where the uterine sinuses were bleeding due to atony, and medical management and uterine tamponade failed, with a raised D-dimer level. As the stepwise management failed with uterine devascularisation failing to control PPH, a decision for uterine compression suture (UCS), Cho suture was taken.

scholarly journals Clinical study of post partum haemorrhage from a teaching hospital in Maharashtra, India

2017 ◽  
Vol 6 (6) ◽  
pp. 2366 ◽  
Author(s):  
Fasiha Tasneem ◽  
Shyam Sirsam ◽  
Vijayalakshmi Shanbhag
Keyword(s):  
Teaching Hospital ◽  
Postpartum Haemorrhage ◽  
Post Partum ◽  
Care Center ◽  
Tertiary Care ◽  
Morbidity And Mortality ◽  
Active Management ◽  
Surgical Interventions ◽  
Maternal Morbidity And Mortality ◽  
Post Partum Haemorrhage

Background: To study the cases of postpartum haemorrhage, their causes and management in a tertiary care centre.Methods: A retrospective study of cases of postpartum haemorrhage for a period of 3yrs was conducted in Dept. of OBGY at a rural tertiary care center and teaching hospital in Maharashtra. The major causes, management modalities, morbidity and mortality associated with it were discussed.Results: Out of 37515 deliveries over the period of 3 years (2014-2016), there were 1333 cases of PPH out of which accounted for a prevalence of 3.55%. Study showed that 86% of cases were due to atonic PPH, 9.9% due to traumatic PPH, and 0.97% were due to both atonic and traumatic PPH. 2.7% of cases were due to retained placenta, 0.07% were due to bleeding diathesis.Conclusions: In an era with availability of excellent uterotonics and active management of 3rd stage of labour even today postpartum haemorrhage stands first as the cause of maternal morbidity and mortality. Even though with excellent medical and surgical interventions, maternal mortality due to PPH has been significantly reduced, the field still needs extensive research and new modalities to prevent and manage post-partum haemorrhage.

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