Obstetric hemorrhage: effective methods for addressing the menace in Sub-Saharan Africa
-
Hauwa Musa Abdullahi
,
Labaran Dayyabu Aliyu
Abstract
Obstetric hemorrhage is a serious emergency. It can occur late in pregnancy and in the immediate postpartum period. Postpartum hemorrhage is the major contributor of maternal deaths worldwide. The incidence of PPH-associated death across the African continent is at least three times higher than in other regions of the world. About 17% of PPH result in severe morbidity, including significant organ impairment. Maternal death and disability have long-lasting negative consequences for children, families, and communities. There are considerable variations across regions with for instance PPH accounting for about 8.0% of maternal deaths in developed countries compared to 19.7% in the developing countries. This disparity suggests that the majority of lives lost from PPH are preventable. Instituting primary preventive measures, prenatal care, comprehensive antenatal care, understanding the concept of birth preparedness and complication readiness, skilled birth attendant at delivery, avoiding delays, availability of comprehensive emergency obstetric care (CEmOC), good political will and disseminating the information on maternal mortality from PPH to the community are among key elements necessary to address the menace of PPH in developing countries. The aim of this review is to highlight the contributions of obstetric hemorrhage as a significant cause of maternal morbidity and mortality and suggest measures of prevention.
-
Research funding: None declared.
-
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
-
Competing interests: Authors state no conflict of interest.
-
Informed consent: Not applicable.
-
Ethical approval: Not applicable.
References
1. Sarah, BH, Poggi, MD. Postpartum hemorrhage and the abnormal puerperium. In: Decherney, AH, Nathan, L, Laufer, N, Roma, AS, editors. Current diagnosis and treatment obstetrics and gynaecology, 11th ed. New York: Mc-Graw Hill Lange; 2013:349–56 pp.Search in Google Scholar
2. Nathan, LM. An overview of obstetric hemorrhage. Semin Perinatol 2019;43:2–4. https://doi.org/10.1053/j.semperi.2018.11.001.Search in Google Scholar PubMed
3. Sheldon, W, Blum, J, Vogel, J, Souza, J, Gülmezoglu, A, Winikoff, B. Postpartum haemorrhage management, risks, and maternal outcomes: findings from the World Health Organization multicountry survey on maternal and newborn health. BJOG 2014;121:5–13. https://doi.org/10.1111/1471-0528.12636.Search in Google Scholar PubMed
4. Ngwenya, S. Postpartum hemorrhage: incidence, risk factors, and outcomes in a low-resource setting. Int J Wom Health 2016;8:647–50. https://doi.org/10.2147/IJWH.S119232.Search in Google Scholar PubMed PubMed Central
5. Say, L, Chou, D, Gemmill, A, Tuncalp, O, Moller, AB, Daniels, et al.. Global causes of maternal death: a WHO systematic analysis. Lancet Global Health 2014;2:e323–33. https://doi.org/10.1016/S2214-109X(14)70227-X.Search in Google Scholar PubMed
6. Kramer, MS, Berg, C, Abenhaim, H, Dahhou, M, Rouleau, J, Mehrabadi, A, et al.. Incidence, risk factors, and temporal trends in severe post-partum hemorrhage. Am J Obstet Gynecol 2013;209:449. https://doi.org/10.1016/j.ajog.2013.07.007.Search in Google Scholar PubMed
7. Garba, Z, Abdullahi, HM, Yusuf, M, Takai, IU, Muhammad, ID. Appropriate documentation of the timing of events in the management of women with postpartum hemorrhage in aminu Kano teaching hospital: a two-year audit. Niger Med J 2019;60:9–12. https://doi.org/10.4103/nmj.NMJ10.4103/nmj.NMJ_5_19.Search in Google Scholar
8. Bateman, BT, Berman, MF, Riley, LE, Leffert, LR. The epidemiology of postpartum hemorrhage in a large, nationwide sample of deliveries. Anesth Analg 2010;1:1368–73. https://doi.org/10.1213/ANN10.1213/ane.0b013e3181d74898.Search in Google Scholar
9. Sentilhes, L, Merlot, B, Madar, H, Sztark, F, Brun, S, Deneux-Tharaux, C. Postpartum haemorrhage: prevention and treatment. Expet Rev Hematol 2016;9:1043–61. https://doi.org/10.1080/17474086.2016.1245135.Search in Google Scholar PubMed
10. Halle-Ekane, G, Emade, F, Bechem, N, Palle, J, Fongaing, D, Essome, H, et al.. Prevalence and risk factors of primary postpartum hemorrhage after vaginal deliveries in the bonassama district hospital, Cameroon. Int J Trop Dis Health 2016;13:1–12. https://doi.org/10.9734/IJTDH/2016/23078.Search in Google Scholar
11. Sosa, CG, Althabe, F, Belizán, JM, Buekens, P. Risk factors for postpartum hemorrhage in vaginal deliveries in a Latin-American population. Obstet Gynecol 2009;113:1313–9. https://doi.org/10.1097/AOG.0b013e3181a66b05.Search in Google Scholar PubMed PubMed Central
12. Gulumbe, U, Alabi, O, Omisakin, OA, Omoleke, S. Maternal mortality ratio in selected rural communities in Kebbi State, Northwest Nigeria. BMC Pregnancy Childbirth 2018;18:503. https://doi.org/10.1186/s12884-018-2125-2.Search in Google Scholar PubMed PubMed Central
13. Hofmeyr, GJ, Qureshi, Z. Preventing deaths due to haemorrhage. Best Pract Res Clin Obstet Gynaecol 2016;36:68–82. https://doi.org/10.1016/j.bpobgyn.2016.05.004.Search in Google Scholar PubMed
14. Lian, L, Richard, FW, Momade, C, Ines, B, Patricia, S, Annette, VD. Maternal death and postpartum hemorrhage in Sub-Saharan Africa – a pilot study in metropolitan Mozambique. Res Pract Thromb Haemost 2020;4:402–12. https://doi.org/10.1002/rth2.12311.Search in Google Scholar PubMed PubMed Central
15. Kassebaum, NJ, Barber, RM, Bhutta, ZA, Dandon, L, Gething, PW, Haysi, SI, et al.. Global, regional, and national levels of maternal mortality, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 2016;388:1775–181. https://doi.org/10.1016/S0140-6736(16)31470-2.Search in Google Scholar PubMed PubMed Central
16. Tort, J, Rozenberg, P, Traore, M, Fournier, P, Dumont, A. Factors associated with postpartum hemorrhage and maternal death in referral hospitals in Senegal and Mali: a cross-sectional epidemiological survey. BMC Pregnancy Childbirth 2015;235:15. https://doi.org/10.1186/s12884-015-0669-y.Search in Google Scholar PubMed PubMed Central
17. Miteku, AL, Habitamu, GB, Habitamu, AT. Birth preparedness, readiness planning and associated factors among mothers in Farta district, Ethiopia: a cross-sectional study. BMC Pregnancy Childbirth 2019;19:171. https://doi.org/10.1186/s12884-019-2325-4.Search in Google Scholar PubMed PubMed Central
18. Smith, JM, Baawo, SD, Subah, M, Sirtor-Gbassie, V, Howe, CJ, Ishola, G, et al.. Advance distribution of misoprostol for prevention of postpartum hemorrhage (PPH) at home births in two districts of Liberia. BMC Pregnancy Childbirth 2014;189:14. https://doi.org/10.1186/1471-2393-14-189.Search in Google Scholar PubMed PubMed Central
19. Markos, D, Bogale, D. Birth preparedness and complication readiness among women of child bearing age group in Goba Woreda, Oromia Region, Ethiopia. BMC Pregnancy Childbirth 2014;14:282. https://doi.org/10.1186/s12884-019-2325-4.10.1186/1471-2393-14-282.Search in Google Scholar
20. Kemal, G, Yusuf, O, Varol, G, Mustapha, K. Active management of the third stage of labour: a brief overview of key issues. Turk J Obstet Gynecol 2018;15:188–92. https://doi.org/10.4274/tjod.39049.Search in Google Scholar PubMed PubMed Central
21. WHO. Recommendations for the active management of the third stage of labour (AMTSL). Geneva: WHO; 2022. http://apps.who.int/iris/bitstream/10665/120082/1/WHO_RHR_14.20_eng.pdf [Accessed 20 Jan 2022].Search in Google Scholar
22. Herrick, T, Mvundura, M, Burke, TF, Abu-Hydar, E. A low-cost uterine balloon tamponade for management of postpartum hemorrhage: modeling the potential impact on maternal mortality and morbidity in Sub-Saharan Africa. BMC Pregnancy Childbirth 2017;374:17. https://doi.org/10.1186/s12884-017-1564-5.Search in Google Scholar PubMed PubMed Central
23. Ayadi, AM, Butrick, E, Geissler, J, Miller, S. Combined analysis of the non-pneumatic anti-shock garment on mortality from hypovolemic shock secondary to obstetric hemorrhage. BMC Pregnancy Childbirth 2013;13:208. https://doi.org/10.1186/1471-2393-13-208.Search in Google Scholar PubMed PubMed Central
24. Mobeen, N, Durocher, J, Zuberi, N, Jahan, N, Blum, J, Wasim, S, et al.. Administration of misoprostol by trained traditional birth attendants to prevent PPH in home births in Pakistan: a randomised placebo-controlled trial. BJOG 2011;118:353–61. https://doi.org/10.1111/j.1471-0528.2010.02807.x.Search in Google Scholar PubMed PubMed Central
25. Hinshaw, K. Tranexamicacid for post partum haemorrhage in the WOMAN trial. Lancet 2017;390:1582–3. https://doi.org/10.1016/S0140-6736(17)31956-6.Search in Google Scholar PubMed
26. Ramler, PI, Akker, T, Henriquez, DD, Zwart, JJ, Roosamalen, J. Incidence, management and outcome of women requiring massive transfusion after childbirth in the Netherlands: secondary analysis of a nationwide cohort study between 2004 and 2006. BMC Pregnancy Childbirth 2017;197:17. https://doi.org/10.1186/s12884-017-1384-7.Search in Google Scholar PubMed PubMed Central
27. Polonsky, NJ, Renzaho, AM, Brijnath, B. Barriers to blood donation in African communities in Australia: the role of home and host country culture and experience. J AABB Transfus 2011;51:1809–19. https://doi.org/10.1111/j.1537-2995.2010.03053.x.Search in Google Scholar PubMed
28. Ojifinni, OO, Ibisomi, L. Preconception care practices in Nigeria: a descriptive qualitative study. Reprod Health 2020;172:17. https://doi.org/10.1186/s12978-020-01030-6.Search in Google Scholar PubMed PubMed Central
29. Ekem, NN, Lawani, LO, Onoh, RC, Iyoke, CA, Ajah, LO, Onwe, EO, et al.. Utilisation of preconception care services and determinants of poor uptake among a cohort of women in Abakaliki Southeast Nigeria. J Obstet Gynaecol (Lahore) 2018;38:739–44. https://doi.org/10.1080/01443615.2017.1405922.Search in Google Scholar PubMed
30. Priya, VR, Deborah, AW. Postpartum hemorrhage: evidence-based medical interventions for prevention and treatment. Clin Obstet Gynecol 2010;53:165–81. https://doi.org/10.1097/GRF.0b013e3181ce0965.Search in Google Scholar PubMed
31. Royal College of Obstetricians and Gynecologists London. Prevention and management of postpartum hemorrhage. Green-Top guideline. No. 52; 2016. https://obgyn.onlinelibrary.wiley.com/doi/full/10.1111/1471-0528.14178 [Accessed 19 Jan 2022].Search in Google Scholar
32. Rath, WH. Postpartum hemorrhage–update on problems of definitions and diagnosis. Acta Obstet Gynecol Scand 2011;90:421–8. https://doi.org/10.1111/j.1600-0412.2011.01107.x.Search in Google Scholar PubMed
33. Tunçalp, O, Souza, JP, Gülmezoglu, M. New WHO recommendations on prevention and treatment of postpartum hemorrhage. Int J Gynaecol Obstet 2013;123:254–6. https://doi.org/10.1016/j.ijgo.2013.06.024.Search in Google Scholar PubMed
© 2022 Walter de Gruyter GmbH, Berlin/Boston
Articles in the same Issue
- Frontmatter
- Review
- Obstetric hemorrhage: effective methods for addressing the menace in Sub-Saharan Africa
- Mini Review
- The use of neurally-adjusted ventilatory assist (NAVA) for infants with congenital diaphragmatic hernia (CDH)
- Opinion Paper
- The role of specialist perinatal psychiatrists in modern medicine
- Corner of Academy
- Maternal perception of fetal movements: onset and associated factors
- Original Articles – Obstetrics
- Cervical ripening as an outpatient procedure in the pandemic – minimizing the inpatient days and lowering the socioeconomic costs
- Can sonographic imaging of the fetal pancreas predict perinatal outcomes in gestational diabetes mellitus?
- Comparison of transvaginal sonographic cervical length measurement and Bishop score for predicting labour induction outcomes
- Regional differences in utilization of 17α-hydroxyprogesterone caproate (17-OHP)
- Effect of anesthesia selection on neonatal outcomes in cesarean hysterectomies for placenta accreta spectrum (PAS)
- Bile-acid levels and lung maturity test in patients with intrahepatic cholestasis of pregnancy
- Evaluation of appropriate vancomycin prescribing for the prevention of newborn group B streptococcal infections in a community hospital obstetrics service
- Effect of supplementation with 5,000 IU of vitamin D on the glycemic profile of women with gestational diabetes mellitus
- Association of methylenetetrahydrofolate reductase (MTHFR) gene polymorphisms with vitamin B12 deficiency and adverse perinatal outcomes among pregnant women of rural South India – a cross sectional longitudinal study
- Original Article – Fetus
- Fetal autopsy for the diagnosis of skeletal dysplasia and comparison with prenatal ultrasound findings over a 16-year period
- Original Articles – Neonates
- Neonatal admission rate after vaginal breech delivery
- Extremely low gestational age neonates and resuscitation: survey on perspectives of Canadian neonatologists
- The effect of 150 and 80 mg doses of aspirin on preventing preterm birth in high-risk pregnant women
- Letters to the Editor
- Aspirin for the prevention of preeclampsia
- Reply to: Aspirin for the prevention of preeclampsia
- Total bile acid levels for clinically suspected intrahepatic cholestasis of pregnancy
- Reply: Neonatal lung injury with intrahepatic cholestasis of pregnancy
- Marijuana and pregnancy: just because its legal doesn’t make it safe
- Corrigenda
- Stillbirth aftercare in a tertiary obstetric center–parents’ experiences
- Prospective risk of stillbirth according to fetal size at term
Articles in the same Issue
- Frontmatter
- Review
- Obstetric hemorrhage: effective methods for addressing the menace in Sub-Saharan Africa
- Mini Review
- The use of neurally-adjusted ventilatory assist (NAVA) for infants with congenital diaphragmatic hernia (CDH)
- Opinion Paper
- The role of specialist perinatal psychiatrists in modern medicine
- Corner of Academy
- Maternal perception of fetal movements: onset and associated factors
- Original Articles – Obstetrics
- Cervical ripening as an outpatient procedure in the pandemic – minimizing the inpatient days and lowering the socioeconomic costs
- Can sonographic imaging of the fetal pancreas predict perinatal outcomes in gestational diabetes mellitus?
- Comparison of transvaginal sonographic cervical length measurement and Bishop score for predicting labour induction outcomes
- Regional differences in utilization of 17α-hydroxyprogesterone caproate (17-OHP)
- Effect of anesthesia selection on neonatal outcomes in cesarean hysterectomies for placenta accreta spectrum (PAS)
- Bile-acid levels and lung maturity test in patients with intrahepatic cholestasis of pregnancy
- Evaluation of appropriate vancomycin prescribing for the prevention of newborn group B streptococcal infections in a community hospital obstetrics service
- Effect of supplementation with 5,000 IU of vitamin D on the glycemic profile of women with gestational diabetes mellitus
- Association of methylenetetrahydrofolate reductase (MTHFR) gene polymorphisms with vitamin B12 deficiency and adverse perinatal outcomes among pregnant women of rural South India – a cross sectional longitudinal study
- Original Article – Fetus
- Fetal autopsy for the diagnosis of skeletal dysplasia and comparison with prenatal ultrasound findings over a 16-year period
- Original Articles – Neonates
- Neonatal admission rate after vaginal breech delivery
- Extremely low gestational age neonates and resuscitation: survey on perspectives of Canadian neonatologists
- The effect of 150 and 80 mg doses of aspirin on preventing preterm birth in high-risk pregnant women
- Letters to the Editor
- Aspirin for the prevention of preeclampsia
- Reply to: Aspirin for the prevention of preeclampsia
- Total bile acid levels for clinically suspected intrahepatic cholestasis of pregnancy
- Reply: Neonatal lung injury with intrahepatic cholestasis of pregnancy
- Marijuana and pregnancy: just because its legal doesn’t make it safe
- Corrigenda
- Stillbirth aftercare in a tertiary obstetric center–parents’ experiences
- Prospective risk of stillbirth according to fetal size at term
