Factors Contributing to Post-Partum Hemorrhage Among Pregnant Women Delivering in Kampala International University-Teaching Hospital

TABLE OF CONTENTS

ABSTACT.......................................................................................................................................i

DECLARATION..........................................................................................................................iii

APPROVAL .................................................................................................................................iv

ACKNOWLEDGEMENT............................................................................................................ v

TABLE OF CONTENTS............................................................................................................. vi

LIST OF TABLES ........................................................................................................................ x

LIST OF FIGURES ..................................................................................................................... xi

DEFINITIONS OF KEY TERMS.............................................................................................xii

LIST OF ABREVIATIONS ......................................................................................................xiii

CHAPTER ONE ........................................................................................................................... 1

1.0 INTRODUCTION................................................................................................................. 1

1.1 BACKGROUND................................................................................................................... 1

1.2 STATEMENT OF THE PROBLEM ..................................................................................... 2

1.3 PURPOSE OF THE STUDY ................................................................................................. 3

1.4 SPECIFIC OBJECTIVES...................................................................................................... 3

1.4 RESEARCH QUESTONS..................................................................................................... 4

1.5 JUSTIFICATION OF THE STUDY...................................................................................... 4

CHAPTER TWO: LITERATURE REVIEW............................................................................ 5

2.0 INTRODUCTION................................................................................................................. 5

vii

2.1 MATERNAL RELATED FACTORS CONTRIBUTING TO PPH ...................................... 5

2.1.1. Socio-demographic Characteristics of the Study Population. ....................................... 5

2.1.2 Socio – obstetrics Characteristics. .................................................................................. 6

2.2.3 Causes of PPH due to uterine over distension ................................................................ 7

2.2.4 Labor and Child Birth..................................................................................................... 7

2.2.6 Clinical (Medical, Surgical and Gynecological) Characteristics.................................... 8

2.3 HEALTH WORKERS RELATED FACTORS THAT CONTRIBUTE TO PPH. ................ 9

2.3.1 Qualification of the birth attendant................................................................................. 9

CHAPTER THREE: METHODOLOGY................................................................................. 11

3.0 INTRODUCTION. ............................................................................................................. 11

3.2 STUDY DESIGN & RATIONALE. .................................................................................. 11

3.3 STUDY SETTING AND RATIONALE............................................................................ 11

3.4 STUDY POPULATION. ................................................................................................... 12

3.4.1 SAMPLE SIZE DETERMINATION.............................................................................. 12

3.4.2 SAMPLING PROCEDURE............................................................................................ 13

3.4.3 Inclusion criteria. .......................................................................................................... 14

3.4.4 Exclusion criteria. ....................................................................................................... 14

3.5 STUDY VARIABLES......................................................................................................... 14

3.5.1 Dependent variables...................................................................................................... 14

3.5.2 Independent variables................................................................................................. 14

3.6 RESEARCH INSTRUMENTS............................................................................................ 15

3.7 DATA COLLECTION PROCEDURE. ............................................................................. 15

viii

3.7.1 DATA MANAGEMENT. ........................................................................................................ 15

3.7.2 DATA ANALYSIS............................................................................................................... 15

3.8 ETHICAL CONSIDERATIONS ....................................................................................... 16

5.6 LIMITATIONS OF THE STUDY ............................................................................................ 16

3.10 DISSEMINATION OF RESULTS.................................................................................... 17

CHAPTER FOUR: RESULTS .................................................................................................. 18

4.0 INTRODUCTION ..................................................................................................................... 18

4.1 MATERNAL DEMOGRAPHIC CHARACTERISTICS. .................................................................... 18

4.2 MATERNAL RELATED FACTORS CONTRIBUTING TO PPH. ...................................................... 20

4.3 PREVALENCE OF POSTPARTUM HAEMORRHAGE .................................................................... 26

4.4 HEALTH WORKERS RELATED FACTORS CONTRIBUTING TO POSTPARTUM

HAEMORRHAGE. ......................................................................................................................... 27

CHAPTER FIVE: DISCUSSION.............................................................................................. 29

5.0 INTRODUCTION ..................................................................................................................... 29

5.1 PREVALENCE ........................................................................................................................ 29

5.1.1 MATERNAL DEMOGRAPHIC CHARACTERISTICS .................................................................. 29

5.1.2 MATERNAL RELATED FACTORS CONTRIBUTING TO PPH.................................................... 31

5.1.3 HEALTH WORKERS’ RELATED FACTORS CONTRIBUTING TO PPH ....................................... 33

5.2 CONCLUSIONS....................................................................................................................... 34

5.3 RECOMMENDATIONS............................................................................................................. 35

5.4 IMPLICATION ON THE NURSING PRACTICE ............................................................................. 35

ABSTRACT Statement of the problem: Postpartum haemorrhage is the World’s leading cause of maternal death and accounts for an estimated 127,000 deaths each year. Identification of some of the risk factors such as; previous postpartum haemorrhage, multiple pregnancies, macrosomia, induction of labour, operative vaginal deliveries and cesarean section would help in preventing PPH. In Uganda PPH accounts for 25% of maternal death related to PPH. Purpose of the study: To assess the factors contributing to Postpartum Haemorrhage (PPH) among pregnant women who attend delivery services in Kampala International University, Teaching Hospital (KIU-TH). Study design and rationale: This study used a cross-sectional descriptive designed where by a cross-section of respondents involving 68 respondents were sampled to represent the target population in these case women who receive maternity service from KIU-TH. Only quantitative methods of data collection using questionnaires with closed ended questions were employed for both mothers and Health Workers. A cross sectional study is the one that is carried out at one point in a time or over a short period of time. Results: During the study period 58 women who delivered in the unit and 20 women developed postpartum haemorrhage giving the frequency of postpartum haemorrhage 34.6%. The majority of the women 30% were between 30-34 years of age. Among the women who developed PPH retained placental tissues was the most common cause 50% followed by uterine atony which was 30%. The rest of the causes of PPH were laceration 20%. Conclusion: Postpartum haemorrhage is still a leading but preventable cause of maternal morbidity and mortality in our country due to underutilization of health facilities, the major cause is retained placental tissues followed by uterine atony