Significance of Post-Partum Hemorrhage
Discuss about the Managing The Post-Partum Hemorrhage.
Interventions of the antenatal health education that can influence on an antenatal mother for managing the post-partum hemorrhage.
In the developing world, maternal death rates have reduced but postpartum hemorrhage remains to be the main trauma and it is the main reason for high maternal mortality rates. It is common among those women who incur gestation period of more than 8 months. The year 2013, 17 deaths in each group of one thousand live births occurred in united states and eleven percent of this deaths were caused by postpartum hemorrhage. Research by World Health Organization shows that sixty percent of one thousand deaths per hundred thousand live births is due to postpartum hemorrhage. This results in a large number of deaths per year and may result in the death of one woman in a duration of four minutes. From the year 1999 to 2009 the rate of postpartum deaths increased from 1.5% to 4.1%. this failure is brought by lack of good caregivers with the needed knowledge, giving same medication for early postpartum hemorrhage and late postpartum hemorrhage, lack of blood transfusion facilities, reduction of pain operations and presence of disorders. Postpartum hemorrhage is a situation where vaginal delivery cause blood loss of more than 500ml and cesarean delivery cause blood loss of more than 100ml in 24 hours.
What are the interventions of the antenatal health education that can influence on an antenatal mother for managing the post-partum hemorrhage?
Pieces of evidence were conducted online used COCHRANE, CINNAL and UOW database systems which are available from the University of Wollongong Library. Based on the search question, the concepts of the search strategy are postpartum, hemorrhage, management and antenatal. The term education was not highlighted in the search because many of the articles addressed of managing the problem of postpartum hemorrhage and the ways to control it. The article also concentrated much on the causes of postpartum hemorrhage.
The research was done purely in the English language in articles ranging from the year 2008 and 2018, ten article were found and all were included in the review and well analyzed. They were all focusing on how to reduce the rate of deaths due to postpartum hemorrhage.
The studies were conducted and examined based under several interventions of antenatal health education for managing postpartum hemorrhage: (a) medication (b) uterine massage (c) removing remains of the placenta in the uterus (d) pelvic tissue repair (e) Foley balloon (f) use of surgery (g) sealing bleeding vessels (Evensen and Anderson, 2018 pp 445).
- Medication
Question for Literature Review
The medicines used for management of postpartum hemorrhage management are syntometrine, oxytocin, carbetocin, hemabate, misoprostol, carboprost, and ergotamine.
Oxytocin is used when there is a failure in the contraction of uterine walls, it enhances the contraction and it does it in a way that it will last, in case there is no oxytocin misoprostol can be used in small amounts as it can lead to high blood temperatures (Abdel-Aleem and El-Sonoosy, 2006). The third stage of labour is managed by combining syntocinon and ergometrine in a process called syntometrine. Each can work alone but the combination is more effective.
Ergometrine can also be used for tone uterine wall but with caution as it can cause high blood pressure and excessive pain after use. Carbetocin is also used in cases of vaginal deliveries and caesarean sections for women who need a uterine massage. It has fewer effects compared to the other medications (Attilakos and Psaroudakis, 2010). Methylergometrine and tranexamic acid can be used to reduce bleeding a day aft6er birth or during blood transfusion. They are effective when given in a range of three hours after birth (Abdel-Aleem and Alhusaini, 2013).
- Uterine massage
Uterine massage is the gently rubbing the uterus from the outer part of abdomen until bleeding ceases. After delivery of placenta uterine massage is done to improve the contraction of the uterine wall during the third stage of labour. It also softens the walls making it easy for the placenta to detach from the wall of the uterus. Uterine massage also improves the flow of blood in the uterine wall (Abdel-Aleem and Singata, 2010).
- Removal of placenta remains from the uterus
If the placenta is not delivered within the first thirty minutes after birth, the uterine wall will not be free to contract and this may lead to excessive loss of blood. Bleeding may also occur from the part where the placenta is attached. The removing is done in two ways, one, the whole placenta is removed, two, removal of some parts which remain attached to the uterine wall (Jongkolsiri and Manotaya, 2009).
There several ways in which placenta can be removed, one, removal of placenta using the doctor’s hand, this may lead to infections. Two, use of medicine to make the uterine wall contract and relax and this will help to get rid of the placenta. Three, breastfeeding. This help in the release of hormones which help the uterine wall contract hence detaching the placenta from the walls. Four, the full bladder may be the reason for the failure of removal of placenta so emptying it through urinating may help (Badhwar and Singh, 1991).
- Pelvic, vagina tissue repair
Search Strategy
If any rapture occurs during birth a surgical repair is needed to prevent excessive bleeding. People who are at high risk of vaginal tears are those who are delivering for the first time, those with babies of high weight, those who take long to give birth and those who were assisted by midwives by use of forceps of other methods (Andersen and Andersen, 1998). There are home ways which can be used to deal with vaginal tears. These include the use of ice packs, placing the ice on the affected area for about 15 minutes can help in reducing bleeding and the rate of swelling (Patwardhan and Sawant, 2018 pp 349).
Use of stool softeners such as Colace which make it easy for a bowel movement. Observing cleanness and staying dry, using warm water in a squeeze bottle of filling the birth with warm water and sitting there for few minutes to free your skin from dirt. Resting to avoid strenuous activities may help in quick healing.
There several ways to prevent vaginal tears although some are unavoidable, vaginal tears can be avoided through practicing Kegel exercises before giving to strengthen the pelvic tissue, prenatal vitamins may also be used, taking balanced diet, keeping good health status and doing exercises. Softening muscles through warming up the perineum to increase blooding circulation. To avoid worsening of the tears one should avoid salt water for baths, perfumes, using hot water in squeezing bottles, strenuous activities such as squatting, sexual activities, avoid tampons and vaginal cleansers.
- Intrauterine balloon
Because all this other method of dealing with postpartum hemorrhage, intrauterine balloon tamponade remains as the only safe suggestion to deal with post hemorrhage. It is easy to use and give the mother guarantee to bear other children later. There are multiple of these balloons, they include BT-Cath balloon tamponade, Bakri balloon, Foley balloon, condom balloon, Bakri balloon and the Rusch balloon catheter. Experts approve the use of Bakri and the BT-Cath postpartum balloon catheter and in case these are not available then the others can be useful (Revert and Rozenberg, 2018).
These balloons help to exert pressure inwards and outwards to reduce blood loss from the myometrium and the endometrium. The pressure presses on the bleeding parts preventing the pouring of blooding and fastening clotting.
- Use of surgery
There are two types of surgery when it comes postpartum hemorrhage. These are laparotomy and hysterectomy. Laparotomy is the surgery to find the cause of bleeding by opening the abdomen while hysterectomy is the surgery done to remove the uterine wall and is done as the last option. These two operations are done when there is a uterine rupture, trauma issues, and cervical lacerations. Surgery can only be done by experts to avoid causing unnecessary deaths. This is also the last option if only the other practices fail to work out the problem (Wilcox and Ramprasad, 2018 pp 520).
- Sealing bleeding vessels
Summary of Evidence
Sealing of walls and bleeding vessels is done by use of compression sutures, use of gel, coils, and specific glues. This is done by experts to avoid contamination and transmission of infections from dirty objects and hands. They are easy to use and they are not expensive compared to the other practices in this paper. Keeping the tone services dry may also help because clotting will not long to take place.
- The critical review of evidence
In the modern developing world, the deaths caused by postpartum hemorrhage have reduced from 4% to 1.3% due to use of all ways discussed above. Some of these ways are invasive but they save lives of large numbers. Many people may decide not to use these ways as they lack knowledge on their benefits. In areas where postpartum hemorrhage is not dealt well with, high rate of deaths is experienced. Each country is fighting to have facilities which will save lives of mothers. Postpartum care gives the mother another chance to give birth to other babies in her lifetime. It also improves the health of the mothers by reducing the rate at which they lose blood. Almost all health centers have knowledge of using these advanced ways of dealing with excessive bleeding after birth and governments are trying to empower the plan by introducing medicinal devices for the same service.
The main advantage of using this way of managing postpartum hemorrhage is that they save lives. They are time-saving and others are easy to use. They give mothers courage to give birth because they are sure that no sequelae will hit them. Some of this ways reduce the rate of blood transfusion avoiding chances of other infections.
There are also limitations to these ways of fighting postpartum hemorrhage, first, they are all expensive so they need a lot of money to be used. In cases where the government offers the support, they are the best. They also need experts because if carelessly used they may cause death. Not all health centers can afford to carry out the above practices because of their expensiveness. Some people may fear to be introduced to these ways because of bad rumors. Some of this practices also have negative effects which cannot be avoided by the victims in hand.
Each government from each country in all corners of the world is fighting against unnecessary deaths. Fighting postpartum hemorrhage is one of the burning issues and putting more effort to reduce deaths caused by it becomes more relevant to the society. The population of mothers in the world is rising up because fewer deaths are experienced during delivery.
Medications for Managing Post-Partum Hemorrhage
Offering education on antenatal health give people hope and they create a health-promoting environment for the mothers. Traditional ways of dealing with postpartum hemorrhage are now not used because they not able to deal with the current complex situations.
Conclusion
In this paper, by using online search from COCHRANE, CINNAL and UOW database systems which are available from the University of Wollongong Library, there were 10 articles which were chosen to analyze ways of managing postpartum hemorrhage. Despite of all challenges experienced in all corners of the world people are trying to their level best to access this practices in order to save lives. people should also be educated on the trending ways of dealing with delivery problems in order to be on the safe side. World Health Organization should also promote the less developed countries to catch up to these levels of standards.
References
Badhwar L, Singh K, Sethi N, Gupta I, Aggarwal N. The value of nipple stimulation in the management of third stage of labour. International Journal of Gynecology and Obstetrics 1991;36 Suppl:16.
EVENSEN, A, ANDERSON, J, & FONTAINE, P 2017, ‘Postpartum Hemorrhage: Prevention and Treatment’, American Family Physician, 95, 7, pp. 442-449, CINAHL Plus with Full Text, EBSCOhost, viewed 1 June 2018.
Wilcox, L, Ramprasad, Abdel-Aleem H, Alhusaini TK, Abdel-Aleem MA, Menoufy M, Gulmezoglu AM. Effectiveness of tranexamic acid on blood loss in patients undergoing elective cesarean section: randomized clinical trial. Journal of Maternal-Fetal & Neonatal Medicine2013;26(17):1705-9.
Andersen B, Andersen LLT, Sorensen T. Methylergometrine during the early puerperium; a prospective randomized double blind study. Acta Obstetricia et Gynecologica Scandinavica 1998;77:54-7.
Attilakos G, Psaroudakis D, Ash J, Buchanan R, Winter C, Donald F, et al. Carbetocin versus oxytocin for the prevention of postpartum haemorrhage following caesarean section: the results of a double-blind randomised trial. BJOG: an international journal of obstetrics and gynaecology2010;117(8):929-36.
Abdel-Aleem H, Singata M, Abdel-Aleem M, Mshweshwe N, Williams X, Hofmeyr GJ. Uterine massage to reduce postpartum hemorrhage after vaginal delivery. International Journal of Gynecology & Obstetrics2010;111(1):32-6.
Jongkolsiri P, Manotaya S. Placental cord drainage and the effect on the duration of third stage labour, a randomized controlled trial. Journal of the Medical Association of Thailand 2009;92(4):457-60.
Abdel-Aleem H, Hofmeyr GJ, Shokry M, El-Sonoosy E. Uterine massage and postpartum blood loss. International Journal of Gynecology & Obstetrics2006;93(3):238-9.
Revert, M, Rozenberg, P, Cottenet, J, & Quantin, C 2018, ‘Intrauterine Balloon Tamponade for Severe Postpartum Hemorrhage’, Obstetrics & Gynecology, 131, 1, pp. 143-149, CINAHL Plus with Full Text, EBSCOhost, viewed 1 June 2018.
Patwardhan, S, Sawant, A, Ismail, M, Nagabhushana, M, & Varma, R 2008, ‘Simultaneous bladder and vaginal reconstruction using ileum in complicated vesicovaginal fistula’, Indian Journal of Urology, 24, 3, pp. 348-351, CINAHL Plus with Full Text, EBSCOhost, viewed 1 June 2018.
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