HAEMORRHAGE-As A Reason For Maternal Mortality

Bleeding, Bleeding and More Bleeding!

The most harrowing reason for the death of any woman following pregnancy-related excessive bleeding is a provocation of excessive blood loss or the worsening of an ongoing blood loss by unskilled caregivers attending to such unfortunate women.

There is a need for all pregnant women to have access to skilled childbirth care all the time, in centres with comprehensive emergency obstetric care facilities.

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About the Book

“Obstetric haemorrhage (bleeding) is defined as blood loss related to pregnancy and childbirth after the 28th week of pregnancy and up to six weeks after delivery”

“Massive obstetric haemorrhage refers to acute blood loss of more than 1,500ml (25-30% of the blood volume) in pregnancy”2 Excessive bleeding is a major direct cause of maternal mortality, whether the excessive bleeding occurred before delivery or after delivery.

In many childbirth centres, bleeding is the commonest single direct reason for maternal death. However, most women with pregnancy-related excessive blood loss will live if they have unhindered access to a skilled childbirth attendant in a centre with emergency obstetric care facilities. This means that most of the women will live if they can quickly be attended to by those trained and experienced to do so and who have access to what it takes to do so. In other words, such caregivers have access to blood transfusion facilities, a functional theatre with the requisite pieces of equipment, experienced staff, relevant drugs, medical and surgical consumables.

The most harrowing reason for the death of any woman following pregnancy-related excessive bleeding is a provocation of excessive blood loss or the worsening of an ongoing blood loss by unskilled caregivers attending to such unfortunate women.

The major reason for death is not that the woman bled but that she was attended to by caregivers whose actions worsened her plight. They have no capacity to respond to her condition appropriately but instead, actually drive her down the precipice to death.

The inappropriate actions of such unskilled childbirth attendants provoke or worsen the excessive bleeding that kills their patients. Some of such provocative acts that can cause excessive bleeding, or worsen bleeding include:

  • Attempting to remove a low-lying placenta vaginally.
  • Partial removal of a retained placenta
  • Failure to remove an extra placental lobe (succenturiate lobe) after delivery of the main placenta
  • Performing, caesarean section for delivery of a dead baby in a woman with coagulation (clotting) defect.
  • Performing caesarean section for antepartum (before delivery) haemorrhage due to abruptio placentae (abnormal separation of a normally sited placenta from the uterine wall) in a woman without a mechanical obstruction to delivery.
  • External cephalic version in a woman with a scar in her uterus provoking uterine rupture.
  • The following procedures produce a scar in the uterus:
  • Caesarean section
  • Myomectomy (fibroid operation) especially when there was an incision of the endometrial plate.
  • Termination of pregnancy or a gynaecological procedure with perforation of the uterus
  • Metroplasty (surgical correction of congenital anomaly of the uterus)
  • Excessive uterine massages, especially on women with a scar in their wombs. These can also lead to rupture of the muscles of the anterior (front) abdominal wall
  • Application of fundal pressure in the face of obstructed labour leading to uterine rupture.
  • Uterine rupture from the inappropriate use of the vacuum extractor.
  • Encouraging maternal expulsive efforts before full cervical dilatation and producing cervical tear and vaginal injury.
  • Cervical and/or vaginal injury due to hyperstimulation of the uterus because of the inappropriate use of uterine stimulants such as oxytocin and/or misoprostol (Cytotec).

Another reason for maternal mortality from excessive bleeding is the inability of childbirth caregivers attending to pregnant or labouring women to respond appropriately to a threat of bleeding. A parturient woman bleeding profusely can die because her peripheral veins had collapsed, and there is no way to access her circulation to give her intravenous injections, infusions or blood because there is no intravenous cannula in-situ.

 

Many women with retained placenta died from excessive bleeding because people attending to them have no skill to manually remove their placentas when childbirth attendants do not have the capacity to rise to the occasion of a challenging childbirth situation like bleeding the result can be disastrous for both the woman and her baby.

The following are such inappropriate responses to a threat of bleeding:

  • Passive management of placental delivery (watchful expectancy)
  • Failure to clamp the umbilical cord following delivery of the baby before delivery of the placenta.
  • Failure to insert an intravenous cannula before delivery making access to the circulation difficult during bleeding.
  • Failure to give intravenous infusions and blood to a woman losing blood excessively
  • Forbidding treatment of malaria and typhoid fever during pregnancy
  • Forbidding pregnant women from taking food rich in protein and vitamins
  • Inability to carry out manual removal of the placenta when the placenta is retained following delivery of the baby.
  • Keeping a fainting woman in the upright or sitting position.
  • Inability to attend to a woman bleeding excessively and the resort to referrals and the challenge of delays.
Details
Author:
Genre: Medical (Social Obstetrics)-Booklet
Tags: Comprehensive Emergency Care, Health, Recommended Books, Specialists, Unskilled Attendance
Publisher: SMEEI
Publication Year: 2019
Format: PDF
ISBN: 9789785724067
eBook Price: 2
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About the Author
Dr Michael Uche-Obasi

By Dr. Michael Uche-Obasi, FWACS is a specialist Obstetrician/Gynaecologist.

He is the president of the Safe Delivery Grace Ministry International and the Safe Motherhood Empowerment and Enlightenment Initiative (SMEEI). He qualified as a medical doctor in June 1985 from the University of Nigeria, Enugu campus.

He is a specialist Obstetrician/Gynaecologist; a Fellow of the West African College of Surgeons. He is a researcher, writer, preacher, clinician, surgeon and student of the word of God. He has written more than 15 books on issues of pregnancy and childbirth.

He enlightens the general public about safe childbirth on television, radio and social media platforms. He organizes programmes for Acquisition of reproductive health life-saving skills by all categories of childbirth attendants.

He also works as a Consultant Obstetrician/Gynaecologist in various outfits of the Safe Motherhood Specialist Maternity Hospital LTD and in Paiyebor Hospital, Port Harcourt, Rivers State Nigeria.

He is married to Crystal and they have five male children; Engr. Lifted Obugorom, Dr Leslie Ikechukwu, Michael, Chimeremeze Great and Blessed Iheoma, and a grand-daughter, Adaeze.

Disclosure of Material Connection: Some of the links in the page above are "affiliate links." This means if you click on the link and purchase the item, I will receive an affiliate commission. I am disclosing this in accordance with the Federal Trade Commission's 16 CFR, Part 255: "Guides Concerning the Use of Endorsements and Testimonials in Advertising."
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