The impact of post-partum haemorrhage in “near-miss” morbidity and mortality in developing countries

Abstract

The global maternal mortality ratio (MMR) of 400 per 100,000 live births results in an estimated 529,000 maternal deaths annually. Most of these deaths occur in developing countries and only about 1% in developed countries. Besides mortality data, the identification and accurate documentation of "near-miss" morbidity (a more sensitive index) is extremely important to assess the quality of health care systems. It can suitably guide to adopt appropriate measures to reduce maternal mortality and morbidity. Haemorrhage remains a major cause of maternal mortality in both developing and developed countries followed by anaemia and infection, which are more common in developing countries. Post-partum haemorrhage (PPH) is a frequent complication of delivery. PPH occurred in 10.5% of all live births worldwide resulting in 13,795,000 cases in the year 2000. The case fatality rate for PPH was 1% and there were 132,000 deaths attributable to PPH. Anaemia as a consequence of PPH was estimated to occur in 1.6 million women every year. Thus, the prevention and adequate management of obstetric haemorrhage are likely to result in a significant reduction in the MMR and in the less frequently monitored "near-miss" morbidity. Strategies to be adopted with regard to PPH in developing countries may differ from those routinely available and practised in developed countries because of limited access to health care facilities and low institutional delivery rate in the former countries. Some low cost, simple techniques to prevent and manage PPH are described. These need to be tested in a wider population to determine which is most suitable for a particular area or country. The mortality and "near-miss" morbidity data should be continually assessed and only then will the impact of these strategies be known.First level midwifery care plus backup by well-equipped hospitals must be developed concomitantly. Anyone can conduct a normal delivery when all is going well but only those with good clinical judgement and the necessary skills will be able to anticipate and manage a problem. This is especially important in the context of PPH where the under-estimation of blood loss coupled with the rapidity of development of serious consequences is the key issue.

Frequency, Distribution by Place of Delivery and Parity, Causes, Management Options and Outcome of Primary Postpartum Haemorrhage in Postpartum Women of District Peshawar, Pakistan

“…24 Maternal mortality in our study was 2%, comparable to other studies. [24][25][26] In a study done at Lahore, maternal mortality among patients with PPPH was 3.9%. 27 It is reported as 5.4% in the study done by Ngwenya.…”

Management of severe postpartum haemorrhage: an updated protocol

“…The portion of the catheter distal to the stomach balloon is cut off before insertion. Tamponade with a condom catheter is another possibility [1,20]. Balloon tamponade predicts within minutes whether the bleeding will stop or surgery will be required.…”

“…This procedure can be easily carried out by trainees while awaiting help from more experienced colleagues. It helps to avoid unnecessary surgery and its subsequent morbidity and mortality [1,19]. 4.…”

“…Worldwide, haemorrhage is the most important cause of pregnancy-related mortality [1]. Knowing how to control bleeding is, therefore, a mandatory skill.…”

Primary Postpartum Hemorrhage; The Effectiveness of Uterine Massage With Active Management as Compared to Active Management Alone, in the Prevention at a Tertiary Care Hospital in Karachi Pakistan

“…The loss of greater than 500ml of blood from the reproductive tract within the initial 24 hours of child birth is referred to as post-partum hemorrhage, which occurs in 2 to 11% of child births 1,2 , both in the developing and the developed countries obstetric hemorrhage is a major player when it comes to morbidity and mortality 3 and about 106 million women suffer from anemia which is a direct result of PPH 4 death from hemorrhage has seen a steady increase being 7 women out of 100,000 child births in 1997-1999 to 17 in 2000-2002 in the UK. 5 An atonic uterus is the primary cause of PPH 6 and its risk factors include prolonged stages of labor, retained placenta, augmented labor, over distention of uterus, placenta accrete, multiparty or previous history of PPH.…”