How Birth Interval and Antenatal Care Affects Postpartum Haemorrhage Prevention in Maiduguri, Nigeria

Abstract

The following work studied how birth interval and antenatal care contribute to occurence of postpartum haemorrhage and how these factors modulates the preventive efficacies of oxytocin injection and misoprostol tablets in postpartum haemorrhage. A total of 1140 pregnant women who have received either oxytocin injection or oral misoprostol in third stage of labour as a prophylaxis of postpartum haemorrhage, were enrolled within three health care facilities in Maiduguri, Nigeria. Each patient was observed at parturition and for 24 h after during which blood lost was estimated to the nearest ml. Maternal characteristics were recorded in a structured proforma. The relationship of the occurrence of PPH (blood loss > 500 ml) and mean blood loss was studied with respect to the prophylactic medication used and some obstetric factors. The occurrence of PPH in subjects that had ‘inadequate’ resting period (29.3 %) was higher than that of the ‘adequate’ resting period group (2 %). Misoprostol exhibited greater PPH prevention in the “inadequate” resting period category (83.9 versus 38.8%). The enrolees that had inadequate antenatal care exhibited higher occurrence of PPH than the adequate group (21.6 versus 16.6%). In the misoprostol medication sub-group, there was significantly (p < 0.001) higher occurrence of PPH in the “adequate ANC” category (37.6%) than in the “inadequate ANC” category (7.1%). Inadequate birth interval and inadequate antenatal care are risk factors for PPH. The relative efficacies of oral misoprostol and parenteral oxytocin significantly vary with varying level of antenatal care and birth interval.