Control of Postpartum Haemorrhage with Uterine Balloon Tamponade Using Foley Catheter in a Rural Mission Hospital in Ebonyi State, Southeast Nigeria

Background: Postpartum haemorrhage is the leading cause of maternal deaths worldwide, the majority of which occur in low resource settings. Uterine atony is the commonest cause of postpartum haemorrhage. Uterine balloon tamponade (UBT) is an effective method of treating refractory postpartum haemorrhage. Aim: Commercial UBT devices are often not affordable and not readily available in rural settings. The aim of this paper is to report on three cases of postpartum haemorrhage successfully managed with uterine balloon tamponade using Foley catheters. Case Reports: We report on three patients with major obstetric haemorrhage from uterine atony who were successfully managed with uterine balloon tamponade using Foley’s urethral catheter. The first two patients had primary postpartum haemorrhage while the third patient had significant bleeding during the surgical evacuation of the uterus for a molar pregnancy. In each case, uterine bleeding was refractory to pharmacologic uterotonics. They all had uterine tamponade with a Foley catheter with the dramatic resolution of their bleeding. Conclusion: In well-selected patients, uterine balloon tamponade with Foley catheter is cheap, arrests bleeding and prevents clinical deterioration among women with refractory postpartum haemorrhage, especially in low resource settings where commercial balloon tamponade may not be available or affordable.

Role of Anterior Division of Internal Iliac Artery Ligation in Refractory Postpartum Haemorrhage—A Tertiary Care Hospital Based Study

Objective: Postpartum haemorrhage (PPH) is one of the important obstetrical emergencies and a leading cause of maternal morbidity and mortality. According to the World Health Organization, postpartum haemorrhage constitutes 25% of all maternal deaths worldwide. In situations where medical line of management fails to control postpartum haemorrhage, anterior division of internal iliac artery ligation can play an important role as a lifesaving and fertility preserving surgical procedure. Keeping this in mind, our study aimed to analyze indications and efficacy of anterior division of Internal Iliac artery ligation in the form of uterine salvage and saving maternal life. Study design: This was a retrospective study carried out in the Department of Obstetrics and Gynaecology, Government Medical College, Aurangabad during the period of July 2014-January 2016. A total of 57 cases that had undergone ligation of anterior division of internal iliac artery were included in the study and different indications and efficacy were studied. Results: Atonic PPH (52.63%) leads the list of indications for ligation anterior division of internal iliac artery ligation followed by traumatic (19.29%), adherent placenta (12.2%), mixed variety (10.52%) and coagulopathy (5.26). Maximum efficacy in terms of preserving fertility and saving maternal life was 73.33% and 93.3% respectively in atonic PPH. Overall efficacy of this procedure in terms of uterine salvage was 54.38% and in terms of saving maternal life was 87.71%. Conclusion: Anterior division of IIAL was effective method in controlling refractory PPH, reducing morbidity and preserving uterus and future fertility. It is safe life saving procedure at experienced hands.

Primary Post-Partum Haemorrhage Following Vaginal Deliveries at the Douala General Hospital: Prevalence, Causes and Risk Factors

Background: Postpartum haemorrhage is one of the leading causes of maternal morbidity and mortality worldwide. It occurs predominantly in developing countries due to poorly developed infrastructures and lack of skilled birth attendants. Objective: To identify the prevalence, causes and risk factors of primary postpartum haemorrhage following vaginal deliveries in a referral hospital (Douala General Hospital-Cameroon). Methods: This was a descriptive and analytical study carried in the Douala General Hospital (DGH) for which socio-demographic, clinical, obstetric and post-partum data were collected using a pre-tested questionnaire. Descriptive statistics, multivariate analysis and logistic regression allowed us to present and discuss our results, with a 95% confidence interval (CI) and p value < 0.05. Results: The prevalence of Primary Postpartum Haemorrhage was 1.33%. Quantification of bleeding was reported in only 13.15% of cases. The main causes were: uterine atony (36.18%), placental retention (25.65%), cervical tears (12.50%), perineal tears (10.52%) and cervico-vaginal tears (08.52%). The risk factors were: age between 19 - 35 years aOR = 4.52;95% CI = 2.65 - 7.98;p = 0.021);unemployment (aOR = 4.74;95% CI = 2.91 - 6.02;p = 0.001);being multigravida (aOR = 9.21;95% CI = 6.43 - 12.48;p = 0.035);history of abortion (aOR = 5.11;95% CI = 2.05 - 7.29;p = 0.004);preterm delivery (aOR = 6.88;95% CI = 2.72 - 9.06;p = 0.002);duration of labour > 12 hours (aOR = 4.05;95% CI = 2.46 - 7.98;p = 0.003) and macrosomia (aOR = 3.27;95% CI = 1.03 - 5.68;p = 0.041). Conclusion: Primary postpartum haemorrhage remains a poorly assessed obstetric complication in the maternity ward of the Douala General Hospital (DGH);Training staff on quantifying postpartum blood loss and monitoring the second and third stages of labour can help to better manage and reduce its occurrence.

Use of iron in perinatal anaemia:Indications for women’s health care policies and procedure

This paper reviews management of obstetric anaemia and the role of intravenous iron for the treatment of obstetric anaemia.Red blood cell transfusions are routinely used for haemoglobin restoration in anaemic women.The decision for red blood cell transfusion is made on a combination of haemoglobin level and clinical status,and it is suggested that transfusions are not necessary in those who are well compensated or when alternative therapy is available.To reduce the risk,intravenous iron infusion is proposed as a bloodless therapeutic approach.There are a variety of iron preparations.Intravenous iron infusion can reduce the requirement for blood transfusion in hemodynamically stable women with perinatal anaemia,especially in resource-scarce settings.It a cost-effective bloodless approach for the treatment of anaemia than can enhance patient outcomes.According to the literature,when haemoglobin is greater than 90 g/L,blood transfusion is not often required.In perinatal women with anaemia,the decision whether to administer blood or iron is based on patient preferences,haemoglobin levels,clinical symptoms,past and present medical conditions and the clinician’s judgement.Nevertheless,due to the lack of rigid criteria for blood transfusions in the majority of clinical settings,it is considered the default treatment for anaemia in perinatal women.

Knowledge and Level of Use of Misoprostol by Health Care Providers in the Maternity Wards of South Kivu in the Practice of Obstetrics

Post-partum haemorrhage (PPH) is one of the leading causes of maternal death in sub-Saharan Africa. In developing countries, PPH is responsible for about 30% of maternal deaths. The main causes of PPH are uterine atony, placental implantation anomalies and coagulation disorders. Acting on the causes of post-partum haemorrhage would significantly reduce maternal mortality. To prevent PPH, the World Health Organization (WHO) recommends the use of uterotonics as a preventive measure. Although parenteral Oxytocin is recommended as the first line Oxytocic for the prevention of PPH, the use of misoprostol is increasingly used in gynaecology and obstetrics, not only for the prevention of postpartum haemorrhage, but also for many other obstetric indications. The aim of this study was to assess the knowledge and level of use of misoprostol by healthcare providers in the gynaecology and maternity departments of South Kivu in the practice of gynaecology and obstetrics. Materials and methods We conducted a descriptive study from January 03 up to February 04, 2023. The study of population was made up of healthcare workers in South Kivu. A questionnaire containing questions relating to socio-demographic informations and knowledge of misoprostol was prepared and encoded in the kobo collect software. To access the questionnaire, it was compulsory to read the research protocol and give consent by ticking the “yes” button. All those who ticked “no” were denied access to the questionnaire. The link was sent, with a request to take part in the survey, to groups in the social networks of doctors and midwives in South Kivu. For areas not covered by the internet, a printed format was distributed and then encoded by data entry operators. For the paper format, respondents were also asked to indicate their consent by ticking the “yes” box. All the encoded data was automatically compiled on the server and then analysed and interpreted by the research team. Results: Nearly all (95.8%) healthcare workers in South Kivu knew about Misoprostol, and only 4.2% did not. The majority (90.1%) of healthcare workers had already used Misoprostol. Providers were aware of the obstetrical indications for Misoprostol, but in most cases, they did not know the dosage recommended by FIGO. For the prevention of post-Partum haemorrhage, only 39.9% use the correct dosage, 42.7% for the treatment of incomplete miscarriage and 49.3% for the treatment of post-Partum haemorrhage. 10% to 21% of providers know the indications of misoprostol but have no idea about dosage. Providers were aware of all routes of administration, but in most cases, they prescribed Misoprostol via the sublingual route (84.5%). The side effects observed by the providers were those already observed in other studies.

Active Management of the Third Stage of Labour: Knowledge and Challenges of Obstetric Caregivers in Selected Health Facilities in Fako Division, Cameroon

Background: In Cameroon, the decrease in MMR (Maternal Mortality Ratio) from PPH (Postpartum Haemorrhage) despite the reported use of the Active Management of the Third Stage of Labour (AMTSL) is slower than what is required to achieve the Third Sustainable Development Goal (SDG3) hence the need to question obstetric caregivers’ competence in AMTSL, as well as the factors hindering its proper use. We therefore aimed to assess obstetric caregivers’ knowledge about AMTSL, as well as the determinants and barriers of AMTSL in selected hospitals in Fako Division, Cameroon. Methods: This was a hospital-based cross-sectional study of 150 participants recruited in 27 health facilities in Buea, Limbe and Tiko health districts from January 15, 2020, to March 31, 2020. Participants’ socio-demographic and qualification characteristics, knowledge and challenges, and the references guiding their practice of AMTSL were collected using a structured questionnaire. AMTSL knowledge was categorized as poor or good and the determinants of good AMTSL knowledge were evaluated. The data was analyzed in SPSS version 25.0. Results: Of the 150 caregivers interviewed, only 48.7% had good knowledge of AMTSL. In logistic models, participants’ use of AMTSL increased Good knowledge of AMTSL (AOR: 12.96, CI: 1.12 - 150.3, p = 0.04). Unavailability of drugs and/or equipment, insufficient staff coverage and lack of knowledge and training of the staff were the major challenges reported. Conclusion: Obstetric caregivers in Fako division have knowledge gaps and face numerous challenges in AMTSL use, which could account for the consistently high MMR from PPH. Filling this knowledge gap and mitigating the challenges of these caregivers would certainly accelerate progress towards the achievement of SDG3.