Primary postpartum hemorrhage (PPH) is the single largest contributor to maternal mortality worldwide.
Throughout Africa and Asia, hemorrhage accounts for
30% or more of all maternal deaths, most of which is PPH
[1]. Even if effective antenatal screening existed, hemorrhage often occurs in women with no identifiable antepartum risk factors. Risk factors in the intra-partum period
may provide opportunity for intervention, or for active
management in the early stages of PPH.
Despite the severe burden of PPH, few studies have
examined risk factors predicting PPH in developing
countries. The primary objective of this study is to investigate the ability to predict PPH by early screening of
women with selected risk factors. We hypothesize that a
combination of ante-partum and intra-partum risk factors will be associated with incidence of PPH, and that
these factors will have utility for screening and clinical
management of labor. The secondary objective of this
studyistoidentifythecomponentsofactivemanagementofthethirdstageoflabor(AMTSL)thathavethe
greatest impact on PPH incidence. AMSTL is a component of internationally accepted clinical protocol for
obstetric management consisting of four components:
use of uterotonics, uterine massage, early cord clamping,
and cord traction. The importance of AMSTL in PPH is
well established, yet the relative importance of each component of the process has not been examined.
Primary postpartum hemorrhage (PPH) is the single largest contributor to maternal mortality worldwide.
Throughout Africa and Asia, hemorrhage accounts for
30% or more of all maternal deaths, most of which is PPH
[1]. Even if effective antenatal screening existed, hemorrhage often occurs in women with no identifiable antepartum risk factors. Risk factors in the intra-partum period
may provide opportunity for intervention, or for active
management in the early stages of PPH.
Despite the severe burden of PPH, few studies have
examined risk factors predicting PPH in developing
countries. The primary objective of this study is to investigate the ability to predict PPH by early screening of
women with selected risk factors. We hypothesize that a
combination of ante-partum and intra-partum risk factors will be associated with incidence of PPH, and that
these factors will have utility for screening and clinical
management of labor. The secondary objective of this
studyistoidentifythecomponentsofactivemanagementofthethirdstageoflabor(AMTSL)thathavethe
greatest impact on PPH incidence. AMSTL is a component of internationally accepted clinical protocol for
obstetric management consisting of four components:
use of uterotonics, uterine massage, early cord clamping,
and cord traction. The importance of AMSTL in PPH is
well established, yet the relative importance of each component of the process has not been examined.
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