Postpartum Haemorrhage In Countries Research Articles

Postpartum Haemorrhage in the Developing World A Review of Clinical Management Strategies

The developing world is disproportionately burdened with high rates of maternal mortality. Despite widespread reduction in maternal deaths due to improved antepartum, intrapartum, and postpartum care in developed nations, mortality rates are persistently high in many countries unable to provide advanced medical care. Postpartum haemorrhage accounts for a substantial proportion of maternal deaths in developing countries. This review addresses the clinical management strategies aimed at the prevention and treatment of postpartum haemorrhage that are effective in lowresource settings. The review was conducted by searching the English-language medical literature using MEDlINE (1950 - Feb 2009) and the online search engine Google Scholar. Four relevant strategies were identified in the literature: active management of the third stage of labour (AMSTl), the use of uterotonic agents including misoprostol, accurate measurement of blood loss, and internal and external compression techniques. Despite known intervention options, additional research on effective management strategies and their implementation is needed to address postpartum haemorrhage in countries of the developing world.

Using Criteria-Based Audit to Improve the Management of Postpartum Haemorrhage in Resource Limited Countries: A Case Study of Malawi

The goal of this study was to assess and improve the management of postpartum haemorrhage (PPH) in maternity units in Malawi. The main objective was to determine whether criteria-based audit can improve adherence to standards for the management of PPH. We used a before-and-after design and univariate statistics for data analysis. A retrospective review of 40 consecutive cases of PPH was conducted in eight hospitals and the results compared with standards for PPH, established based on World Health Organisation manuals. of the audit were presented to healthcare providers who made and implemented recommendations for improvement. A re-audit (45 cases) was conducted 3 months later. There was a significant improvement in adherence to three standards: typing and cross-match carried out (65.0% vs. 84.4%; P = 0.034), patient's hematocrit or haemoglobin established (67.5% vs. 86.7%; P = 0.029), and fluid intake/output chart maintained (0.0% vs 33.3%; P < 0.001). There was no significant change in close monitoring of vital signs (32.5% vs. 53.3%, P = 0.065) and case fatality rate (10.0% vs. 6.7%, P = 0.702), intravenous access achieved and intravenous fluids administered (100.0% vs. 97.8%; P = 0.735), and oxytocic drugs administered (100.0% vs. 95.6%; P = 0.357). Introduction of criteria-based audit can improve the management of postpartum haemorrhage in countries with limited resources. Future studies should consider using larger sample size to evaluate the effect of criteria-based audit on mortality.

A clinical audit of the management of postpartum haemorrhage in Malawi

Objective: To assess and improve the management of postpartum haemorrhage in maternity units in Malawi. Methods: A criterion based audit was conducted in 8 hospitals in three districts in Malawi. A retrospective review of 40 case notes was conducted and the results compared with standards for postpartum haemorrhage, established based on evidence the World Health Organisation manuals. Results of the audit were presented, recommendations made and implemented. A re-audit (45 case notes) was conducted 3 months later. Results: There was a significant improvement in three standards: typing and cross-match carried out (p = 0.034), patient's hematocrit or haemoglobin established (p = 0.029), and fluid intake/output chart maintained (p <0.001). There was a trend towards an improvement in the close monitoring of vital signs (32.5% vs 53.3%) and a trend towards a decrease in case fatality rate (10.0% vs 6.7%). There was no significant change in two standards in which 100% attainment was achieved during the first audit: intravenous access achieved and intravenous fluids administered (100.0% vs 97.8%), and oxytocic drugs administered (100.0% vs 95.6%). Conclusion: Criterion based audit can improve the management of postpartum haemorrhage in countries with limited resources.