INTRODUCTION

Background of the Study

Post-partum haemorrhage is the loss of blood greater than 500ml

following vaginal delivery or 1000ml of blood following caesarean

section. It is the most common cause of maternal death in the

developed world. It is also a major reason of maternal morbidity

worldwide. This is the complication of third stage of labour this is so if

it is within 24 hours after birth is known as primary post-partum

haemorrhage while subsequent to the 24 hours after delivery to 6-8

weeks post-partum is termed as secondary post-partum haemorrhage

(Wikipedia the Free Encyclopedia 2011).

The major causes are: uterine atony 70 percent trauma 20 percent

retained tissue 10 percent and coagulopathy 1 percent. Other factors

includes: poverty illiteracy unavailability of trained medical personnel

as well as mismanagement of the third stage of labour combine to

accentuate these problems especially in Nigeria specifically in the

north-east region (Ujah and Ejeh 2007).

The clinical manifestation includes visible vaginal bleeding which may be

slow trickle or rarely a copious flow. Each woman may experience

symptoms differently; symptoms may include:

● Uncontrolled bleeding

● Decreased blood pressure

● Uterus is soft big and does not contract

● Pallor of the conjunctiva tongue and palms of the hand as well as

sole of the feet.

The aim of treatment is to find out and stop the cause of bleeding as

quickly as possible. The treatment includes; medication to stimulate

uterine contraction manual massage of the uterus to stimulate

contraction also removal of placental tissue that prevent uterine

contraction as well as replacing blood loss (Children’s Hospital and

Health System 2011).

The prevention of PPH is predicated on its anticipation and active

management of the third stage of labour. Several strategies have

prevented or redressed PPH and decreased the incidence of severe form

of PPH and hence maternal mortality.

Post-partum haemorrhage is still ranked among the top 3 major causes

of maternal mortality globally. Although the majority (99 percent) of

deaths reported occur in developing countries the risk of PPH should

not be under-estimated for any birth nor should the potential for the

third stage of labour to be the most dangerous stage of labour be

under-estimated (Myles 2003).

According to John and Catherine (2011) every year nearly 350000

women die worldwide from complication of pregnancy and childbirth

and one of the primary causes is PPH for at least one quarter of all

maternal deaths worldwide and nearly 60 percent of maternal death in

the developing world.

In Nigeria as in other parts of the world PPH is the most common cause

of maternal mortality responsible for about 66 percent of births while in

northern Nigeria PPH is the leading factor for about 53.8 percent of

maternal death. This is commonly due to home birth advance maternal

age (over 35 years) and grand multi-parity. Uterine atony is another

reason responsible for about 70 percent of PPH.

However Yobe state is one of the northern states of Nigeria with high

rate record of PPH. The high rate of PPH in the state is mostly due to

home birth known as birth before arrival (B.B.A). In order to reduce the

incidence of PPH a number of strategies has to be adopted and many

organization are involves with some programmes to demonstrate

strategies in control of PPH in the state such programmes include

continuum of care; addressing PPH in Yobe state which took place on

16-20 May 2011. The programme involves training and re-training of

nurses midwives and other skilled birth attendants on PPH prevention.

Another strategy on PPH is the provision of essential materials for

modern obstetric services under the programme free maternal services

which started since 2008 to date. It is organized by Yobe state

government through the Ministry of Health.

Maryam Abacha Maternal and Child Health Center (MCHC) Damaturu

was established in September 1998 during the then Late President

General Sani Abacha under the programme of Family Support by the

then first lady Maryam Sani Abacha which was named after her. It was

commissioned by the wife of the then military administrator of Yobe

state Mrs. Love Benkalio with about 46 bed capacity 3 wards and mini

laboratory.

The Center also serves as referral ground from rural maternities within

and outside the metropolis. It is also used as a training place for

students from School of Nursing and Midwifery Damaturu as well as

Health Technology Nguru Yobe state. The Center is located along

Gashua road Damaturu Yobe state.

The state is agrarian in nature and consists of 17 local government

areas. It also has rich fishing grounds and possessed some mineral

deposits of gypsum kaolin and quartz. Other agricultural produce

include gum Arabic groundnuts beans and cotton. One of largest cattle

markets in West Africa is located near Potiskum in the state (Canback

Global Income Distribution Database 2008).

The state has educational and health facilities which include primary

secondary and tertiary institutions across the state. The state has the

total area of 45502 km

and with a total population of 2326511 (NPC

2006). Ethnic groups that are living in the state include Fulani Kanuri

Kare-Kare Bolewa Ngizim Bade Hausa Ngamo and Shuwa (Database

2008).

Statement of the Problem

It has been observed that even with the introduction of safe

motherhood life saving skills and free maternal health services in the

state yet women are still being admitted in Maryam Abacha Maternity

Center with about 3-4 out of the 10 patients on admission are said to be

post-partum haemorrhage (Medical Record 2010).

Therefore this motivated the researcher to find out strategies that could

be adopted to prevent post-partum haemorrhage at Maryam Abacha

Center.

Purpose of the Study

The purpose of this study is to find out strategies for controlling

post-partum haemorrhage among women that are attending Maryam

Abacha Maternal and Child Health Center.

Specifically the study will:

1) Determine the level of post-partum haemorrhage among women

attending Maryam Abacha Maternal and Child Health Center.

2) Identify the causes of post-partum haemorrhage among women

that are admitted in Maryam Abacha Maternal and Child Health

Center.

3) Suggest some of the preventive measures that could be taken to

reduce the incidence of post-partum haemorrhage in Maryam

Abacha Maternal and Child Health Center.

Significance of the Study

The study will be beneficial to nurses midwives other health workers

women who are attending the clinic and Maryam Abacha Center. This

research will help to improve the standard and strategies of preventing

post-partum haemorrhage and care given by the nurse and midwives to

women attending the clinic whereby the incidence of post-partum

haemorrhage will be reduce.

The Center also will have reduction in the number of post-partum

haemorrhage (PPH) cases as well as reflecting in the maternal and

morbidity record. This will enable the state to provide necessary

equipment in order to implement strategies of controlling post-partum

haemorrhage.

It will also benefit other researcher by improving their knowledge and

skills on preventing post-partum haemorrhage.

Research Questions

1) What is the level of post-partum haemorrhage among women that

are admitted in Maryam Abacha Maternal and Child Health Center?

2) What are the causes of post-partum haemorrhage among women

that are admitted in Maryam Abacha Maternal and Child Health

Center?

3) What are the preventive measures that could be taken to reduce

the incidence of post-partum haemorrhage in Maryam Abacha

Maternal and Child Health Center?

Scope of the Study

The research study focused on the level causes and preventive

measures of controlling post-partum haemorrhage among women that

are attending Maryam Abacha Maternal and Child Health Center.