Knowledge of Effective Management of Post Partum Haemorrhage Among Nurses

1.1 Introduction

Postpartum haemorrhage is one of the major global causes of maternal morbidity and death. Since there are insufficiently trained birth attendants and inadequate infrastructure, it mostly happens in poorer nations. Worldwide, PPH continues to be the primary cause of maternal fatalities. Information about the severity and risk factors of PPH is, however, scarce in many low- and middle-income countries. Knowing how various risk factors for PPH contribute in proportional terms is crucial.

This chapter will address the background information that motivated this study, the challenges that prompted it, its aim, and its objectives as a preface to subsequent sections of the study. Additional factors include the study's significance, scope, limitations, research questions and hypotheses, and the definition of technical terms.

1.2 Background of Study

Postpartum haemorrhage (PPH) is a major contributor to maternal mortality worldwide (Say et al., 2014). According to Carroli et al. (2008), PPH is 6% prevalent worldwide, with low-income nations bearing the brunt of the disease (AbouZahr, 2003; Sheldon et al., 2014). PPH is prevalent in sub-Saharan Africa, accounting for 10.5% of cases (Carroli et al., 2008). According to National Planning Cycles (2015), PPH accounts for 25% of maternal mortality in Nigeria. The severity and risk factors of PPH, however, are not well understood. PPH is frequently caused by uterine atony, genital tract injury, blood coagulation system failure, and trauma. According to Lutomski et al. (2012), uterine atony accounts for 75% of PPH cases.

Past PPH history, multiple pregnancies, foetal macrosomia, primi-gravida, grand multi-parity, older age, preterm births, genital tract injuries, not using oxytocics for PPH prophylaxis, labour induction, caesarean delivery, and intrauterine foetal deaths are risk factors for PPH (Sheldon et al., 2014; Oberg et al., 2014; Bais et al., 2004; Sheiner et al., 2005; Sosa et al., 2009). The bulk of these investigations, however, used an approach that is highly in accurate visual estimation of blood loss (Al Kadri et al., 2011).

According to Calvert et al. (2012), there aren't many circumstances that are different from low-income nations. This study used a calibrated under-buttocks drape to measure blood loss that is highly correlated with the gold standard measure of photospectometry (Patel et al., 2006).

Knowledge of the risk factors would inform public health interventions for PPH control. To the clinicians, risk factor identification in the antenatal and intrapartum periods may provide an opportunity for timely interventions to prevent PPH. Increasing prevalence of PPH over the years, imbalance between resource rich and resource poor areas are probably due to the combination of increased prevalence of risk factors such as grand multiparity, lack of safe blood banking, non routine use of prophylaxis again haemorrhage, and lack of measures for drugs and surgical management of atony. It is however important to note that various authors have suggested that PPH should be diagnosed with any amount of blood loss that threatens the hemodynamic stability of the woman (Georgiou, 2009; Chelmow, 2011).

Health systems in poor nations confront significant obstacles that make it difficult for them to provide emergency obstetric treatment, which is essential for saving the lives of women who have acquired PPH (Kebebush et al., 2014; Ingvil Krarup Sorbye, 2009). Most poor nations have at least 50% of births handled by inexperienced carers at home; also, medical institutions frequently lack PPH-treating medications or have insufficient staffing (Prata et al., 2013; Mutihir et al., 2011; Naume, 2015). As a result, many medical professionals in underdeveloped nations lack access to basic practical knowledge on PPH, which makes it challenging to identify women who may be at risk for problems that might lead to PPH.

Therefore, in Nigeria where the research was carried out, the activities that was conducted is to examine the Knowledge of Effective Management of Post Partum Haemorrhage Among Nurses.

1.3 Statement of Problems

Investigation revealed that effective management of postpartum haemorrhage requires several elements, such as a trained birth attendant, timely diagnosis and treatment, adequate needed blood transfusion services, and easily accessible health facilities (Naume et al., 2015; WHO et al., 2008). According to Olowokere et al. (2013) and Georgiou et al. (2009), postpartum haemorrhage is the leading cause of death in Nigeria, where the maternal mortality ratio varies from 23 to 23.8%.

Furthermore, in the first six weeks following delivery, 70% of new moms do not receive any postpartum care, and in developing countries, skilled birth attendants are not present for almost half of all deliveries. (Peltzser et al., 2009; Georgiou et al., 2009).

As a consequence of people's misunderstanding and underutilization of the resources available, a number of government-sponsored efforts, including the Millennium Development Goals (MDGs) and safe motherhood, have failed to reduce maternal mortality (Oyetunde et al., 2015; Rousseau et al., 2016). Additionally, many of the women who eventually arrived and gave birth at PHCs went on to acquire PPH (Lynch et al., 2006; Idris et al., 2014; Oyetunde et al., 2015).

1.4 Aim and Objectives of Study

The aim of the study is to examine the Knowledge of Effective Management of Post Partum Haemorrhage among Nurses in Some selected Primary Health Centre. In achieving this aim, the following specific objectives were laid out as follows:

1. To investigate the risk factors inhibiting the effective management of postpartum haemorrhage among Nurses in the area under study;
2. To determine the relationship between the level of Nurses' PPH knowledge and years of working experience;
3. To examine the level of Nurses’ knowledge in recognizing PPH and its causes regard to management; and
4. To proffer solution to the above stated problems of Post Partum Haemorrhage Management among Nurses in the area under study.

1.5 Research Questions

The study came up with research questions so as to be able to ascertain the above stated objectives. The specific research questions for the study are stated below as follows:

• Are there risk factors inhibiting the effective management of postpartum haemorrhage among Nurses in the area under study?
• What is the relationship between the level of Nurses’ postpartum haemorrhage knowledge and years of working experience?
• What is the level of Nurses’ knowledge in recognizing postpartum haemorrhage and its causes regard to management?

1.6 Research Hypothesis

In order to pursue the objective of this study, the following generalized statements have been designed to guide and aids in obtaining the result for the experiment to be conducted. For this work, the null hypothesis will be represented with H0 while the alternative hypothesis will be represented with hypothesis H1.

Hypothesis One

• H0: There are no significant factors inhibiting the management of postpartum haemorrhage among Nurses in the area under study
• H1: There are significant factors inhibiting the management of postpartum haemorrhage among Nurses in the area under study

1.7 Significance of Study

This study will be extremely helpful to the field of midwifery and other researchers who wish to learn more about it. Non-researchers can also use it to further their own research endeavours. This research adds to the body of knowledge and may help direct future investigations.

1.8 Scope of Study

The scope of the research is focused on the Knowledge of Effective Management of Post Partum Haemorrhage among Nurses in Some selected Primary Health Centre. The study utilizes the Enugu State Primary Health Care (PHC) Centre as a case study.

1.9 Limitations of the Study

During the course of this study, there were some problems encountered which stood as limitations to the research work. Some of the limitations include:

1. Time Constraint: The time frame given to accomplish this project was very short due to school academic calendar and it was carried out under pressure which made the researcher not to implement some necessary features.
2. Financial Constraint: Insufficient fund tends to impede the efficiency of the researcher in sourcing for the relevant materials, literature or information and in the process of data collection (internet, questionnaire and interview).
3. Initial Cooperation Delay from Respondents: A particular limitation of this work came as a result of the respondent refusal to offer their cooperation at the initial time they were contacted. This contributed in making the success of this research study difficult.

1.10 Definition of Terms

PPH: It is an acronym for postpartum hemorrhage which is an obstetric emergency.

Postpartum Confinement: It refers to a system for recovery following childbirth.