INCIDENCE OF POSTPARTUM HEMORRHAGE AMONG WOMEN

IN TURAI UMAR YAR’ADUA MATERNAL AND CHILDREN

HOSPITAL KATSINA

BY

MARYAM ABDUSSALAM BANYE

KHD/CHEW/21/0079

JUNE, 2024

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 CHAPTER ONE

INTRODUCTION

1.1 INTRODUCTION

This chapter discusses the background of the study, statement of the study,

research question and scope and delimitation of the study and operational

definition of the terms.

1.2 BACKGROUND OF THE STUDY

It was estimated that the overwhelming death proportion was about half a million

every year due to pregnancy complication, these results t poor or lack of trained

birth attendant. This normally occur in Africa and in some developing countries

of the world. Some place poorly handle their facilities this resulted to death within

few hours of delivery and in most cases are due to postpartum hemorrhage (labor

Zahr antepartum and postpa-tum in hemorrhage in Murray).

Postpartum hemorrhage is one of the most common causes of maternal mortality

worldwide, accounting to 127000 annual, with the highest incidence in

developing country. Postpartum hemorrhage is a preventable condition and early

or timely intervention can prevent development of postpartum hemorrhage

(Khanks, Kunz R Klejinen, Etal). On of such intervention recommended is active

management of the state of labor, it is the only intervention known to prevent

2
postpartum hemorrhage through, even with different intervention and blood

transfusion facility maternal death cannot be brought down to zero, and

significant reduction of women about maternal death.

Postpartum hemorrhage is the leading of maternal death. All women who carry

pregnancy beyond 20 weeks gestation are at risk of postpartum hemorrhage and

its square (John Smith MD, FACOG FRCSD, 2018). Although maternal mortality

rate have declined greatly in the developed world-post-partum hemorrhage

remains the leading cause of maternal mortality elsewhere.

The rates in excess of 1000 women per birth and the World Health Organization

(WHO) statistics suggest that 60% of maternal deaths in developing countries are

due to postpartum hemorrhage accounting for thousands 100,000 maternal death

per year. A practice bulleting from the American College or obstetricians and

gynecologist places the estimate of 140,000 maternal deaths per year or one

women every four minutes.

In Africa and Asia where the most death occur postpartum hemorrhage accounts

for more than 30% of all maternal deaths. (Khan KS at 2007). In Africa due to

increase of prevalence risks factors such as grand multiparty, no routine use of

prophylaxis against obstetric hemorrhage coupled with poor developed obstetric

services, obstetric hemorrhage varies is reasonable for 30% of maternal deaths

attributable to postpartum hemorrhage varies considerably between developed

3
and developing countries suggesting that death from postpartum hemorrhage is

preventable (Khan KS, 2009).

Globally, postpartum hemorrhage remains the leading cause of maternal

mortality in many low income and middle income countries (Dr. Bhanvika K.S,

2018. Maternal mortality due to postpartum hemorrhage continues to be one of

the most important cause of maternal death worldwide (Bhan, K.S, 2018).

It was estimated that, two hundred and four cases of primary postpartum

hemorrhage where compared with the same number of postpartum hemorrhage

mothers during a period of two years (Bhan K.S, 2018) countries, postpartum

hemorrhage usually ranks in the top 3 causes of maternity along, men embolism

and hypertensions. In the developing world several countries have maternal

mortality rates in excess of 100 women per 100,000 birth and world health

organization (WHO) statistics suggest that 25% of maternal death are due to

postpartum hemorrhage, according for more than 100,000 maternal death per year

(John, Arthogras, 2008). The rates of atomics postpartum hemorrhage rise from

1% in 1999 to 3.4% in 2009.

1.3 STATEMENT OF THE PROBLEM

Here are some ways to improve the current situation and move closer to the

desired goals.

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1. Process optimization: Streamline processes, eliminate unnecessary steps,

and automate takes where possible.

2. Staff Training and Development: Provide regular training, up skilling and

reskilling opportunities to enhance staff capabilities.

3. Technology Upgrade: Invest in Modern, efficient and integrated

technology to support data management, analysis and decision making.

4. Effective Communication: Establish clear, regular and transparent

communication channels among stakeholders.

5. Resource Relocation: Relocation resources to prioritize high impact

activities and address resource gaps.

6. Performance Monitoring and Feedback: Establish regular feedback

mechanism to track progress, identify areas for improvement and adjust

strategies accordingly.

7. Change Management: Develop a clear change management plan to address

resistance and ensure a smooth transition.

8. Collaboration and Partnerships: Foster strategic partnerships and

collaborations to leverage resources, expertise and networks.

9. Continuous Improvement Culture: Encourage a Culture of continuous

improvement, experimentation and learning from failures.

10.Data-Driven Decision Making: Base decisions on data analysis and

insights to ensure informed and effective decision making.

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By implementing these strategies, you can address the gasp and obstacles,

improve the current situation and move closer to achieving your desired goals.

1.4 OBJECTIVES OF THE STUDY

1. To determine number of deliveries of women attending Turai Umar

Yar’adua Maternal and Children Hospital Katsina.

2. To determine number of client that had postpartum hemorrhage in post

natal ward at Turai Umar Yar’adua Maternal and Children Hospital

Katsina.

3. To determine the incident of postpartum hemorrhage among women in post

natal ward at Turai Umar Yar’adua Maternal and Children Hospital

Katsina.

1.5 SIGNIFICANT OF THE STUDY

Postpartum Hemorrhage have become a major or challenge to medical

professionals especially doctors and Community Health Practitioners (CHP) and

midwives and a serious concern to Nigerian health community in general.

The researcher hopes at the end of the study it will help and guide Community

Health Practitioners (CHP) midwives and nurses in giving care to patients with

postpartum hemorrhage. Thus reducing the mortality and morbidity rate it will

also add to the body of knowledge existing in Community Health Practitioners

(CHP).

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1.6 RESEARCH QUESTIONS

1. How many pregnant women had hospital delivery in Turai Umar Yar’adu

Maternal and Children Hospital Katsina.

2. How many clients had postpartum hemorrhage in post natal ward at Turai

Umar Yar’adu Maternal and Children Hospital Katsina.

3. What are the incidents of postpartum hemorrhage among women in

postnatal ward at Turai Umar Yar’adua Maternal and Children Hospital,

Katsina.

1.7 SCOPE OF THE STUDY

This study is find out at Turai Yar’adua Maternal and Children Hospital Katsina

the research work was limited to find out the incidence of postpartum hemorrhage

among women at postnatal ward of Turai Umar Yar’adua maternal and children

hospital Katsina. The purpose of this research are to determine number of

deliveries of women attending Turai Umar Yar’adua maternal and children

hospital Katsina. To find out effect of postpartum hemorrhage among women in

postnatal ward at Turai Umar Yar’adua Hospial Katsina, to find out effect of

postpartum hemorrhage among women in postnatal ward at Turai Umar Yar’adua

Maternal Children Health Katsina. Secondary method of data collection is going

to be use in other to answer the search question.

1.8 OPERATIONAL DEFINITION OF THE TERMS

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1. Incidence: The extent to which something happens.

2. Postpartum: A period after childbirth.

3. Hemorrhage: Escape of blood from the blood vessels.

4. Vagina: Is a muscular membranes tube which extend from the vestibule to

the cervix.

5. Pregnancy: Is the period from conception to birth when the egg is fertilized

by sperm and implanted in the lazing of the uterus.

6. Pregnant women: A female human having a baby inside her womb.

7. Postpartum Hemorrhage (PPH): It is a blood loss of 500ml or more from

the reproductive organs after delivery.

8. Primary Postpartum Hemorrhage (PPPH): Is the blood loss occurs during

the 3rd stage of labor and within the first 24hrs of delivery.

9. Secondary Postpartum Hemorrhage (SPH): It’s the excessive bleeding

which occurs after 24hrs and with the 6weeks of delivery.

10.Post natal visit: The past 48 hours following delivery of very crucial to the

survival of both mother and child during the postpartum period.

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 CHAPTER TWO

REVIEW OF RELATED LITERATURE

2.0 INTRODUCTION

This chapter is related to the other studies and research base on Postpartum

Hemorrhage, this includes definition of Postpartum Hemorrhage, types of

Postpartum Hemorrhage, management of Postpartum Hemorrhage and

prevention of Postpartum Hemorrhage.

Definition of Postpartum Hemorrhage is the loss of blood after birth resulting in

hypovolemia or otherwise causing a woman to become symptomatic due to blood

loss. (Barbieri, 2009). Postpartum Hemorrhage can be defined as excessive

bleeding from the genital tract any time following baby’s birth up to 6weeks after

delivery (Margaret, 2007). World Health Organization (WHO, 2007) define

Postpartum Hemorrhage as blood loss that causes major psychological changes

such as low blood pressure which threatens woman’s life, this usually occurs after

birth.

World Health Organization (2005-2007) revealed the reality about having

Postpartum Hemorrhage is that two-third (2/3) of the women who have

experienced Postpartum Hemorrhage had no identifiable clinical risk factors such

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as multiple birth is a veritable opportunity killer, it is believed that poor

malnourished, unhealthy women who delivers away from medical care will die

from Postpartum Hemorrhage where as those that that are fortunate enough to

deliver in well-supplied and staffed medical facility most likely will survive the

three delays at the actual time of birth, delay in the decision to recognize

complication and seek help, delay in accessing transportation to reach medical

facility and delay in receiving adequate and comprehensive care upon arrival.

A widely used definition of Postpartum Hemorrhage by World Health

Organization (WHO, 2018) as any blood loss from the genital tract about 500ml,

within 24hrs.

The average blood loss during normal vaginal birth Postpartum Hemorrhage is

responsible for around one quarter (1/4) of maternal mortality worldwide (WHO,

2017). Reaching as high as 60% in some low income countries, Postpartum

Hemorrhage can also be a cause of severe morbidity approximately 12% of

women who survive from Postpartum Hemorrhage will have severe anemia

(about 2hr Antepartum and Postpartum Hemorrhage in mureg, lopezeds, 2008).

Additionally, women who have severe Postpartum Hemorrhage and survival are

more likely to die in the year following the Postpartum Hemorrhage (Impact

International, 2007).

Postpartum Hemorrhage remains as one of the top three obstetric related causes

of maternal mortality, with the most death occurring within 24-48hrs of delivery.
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Although, Postpartum Hemorrhage relayed mortality has decline globally. It

continues to be a problem more specially the developing world continues to

shoulder a disproportionate share of hemorrhage related death (99%) compare

with industrialized nation (10%). Given the often preventable nature of death

from haemorrhage. The corner store of effective mortality reduction involve

identification of the risk factors, guide diagnosis and timely management.

(Seminars in Perinatology, Volume 36, issue, 2012).

2.1 INCIDENCE OF POSTPARTUM HEMORRHAGE

The incidence of Postpartum Hemorrhage varies medley depending on the criteria

use of define the term. A reasonable estimates 1-5% of deliveries in an analysis

of population based data from United State national inpatient sample for the years

1994-2006, the diagnosis of Postpartum Hemorrhage increased 26% over this

period from (2.3 to 26%) uterine atony was the most common cause of

Postpartum Hemorrhage and accounted for most of the increase. The proportion

of women diagnosed with uterine atony increases from 1.6-2.4% over 12yrs

period, (Friedman, K. Canbellm, 2008). The World Health Organization (WHO)

reports that, obstetrics hemorrhage causes 12, deaths annually worldwide and the

world’s leading cause of maternal mortality. In African countries like Nigeria,

hemorrhage is estimated as responsible for 30% of maternal deaths.

The rates of Postpartum Hemorrhage increase from 1.5% in 1999 to 41% in 2009,

and the rate of a tonic Postpartum Hemorrhage raise from 1% in 1999 to 3.4% in
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2009. The risk of Postpartum Hemorrhage with a morbidly adherent placenta is

markedly higher (Kham KS et al, 2009). The rates of Postpartum Hemorrhage,

decrease from 3.4% to 2.5% in 2015 to 2017, with the rate increasing to 12%

from 2017 to 2018 (Maternity and Child Department Faculty of Nursing, King

Abdulaziz University Jiddah 21151, Saudi Arabia, 2017). The target of

sustainable development goals (SDGs) of the United Nations is to reduce global

maternal mortality rate (MMR) to less than 70 in 100,000 birth by (2030) reduce

baseline rate 2010 to 70% by 2030.

2.1.1 Types of Postpartum Hemorrhage

1. Primary Postpartum Hemorrhage

2. Secondary Postpartum Hemorrhage

Primary Postpartum Hemorrhage

This is defined as estimated blood loss of 500ml or more within the first 2 hours

of birth.

Causes of Primary Postpartum Hemorrhage

1- Uterine a long failure of the uterus to contract properly after birth.

a. Uterine over distension: Multiple pregnanily, hydraminous.

b. Oxytocin: To induce labour uterine atony is the leading cause of

immediate Postpartum Hemorrhage 75-905% (Khan KS et al, 2009).

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 2- Tissue

a. Retained product of conception e.g Placental or membrane.

b. Placenta abnormality: Placenta accrete, succerntutiate lobe.

c. Excessive traction on the cord.

3- Trauma

a. Volvo Virginial Injury

b. Episiotomy

c. Microsomia

4- Thrombin (Coagulopathy)

a. Acquired during pregnancy: Thrombocytopenia of hellpdrome,

pregnancy induced hypertension, sepsis

b. Hereditary, von will band disease.

Secondary Postpartum Hemorrhage

This is define as bleeding from the genital track after 24hrs of delivery it may

occur up to 6 weeks after birth (Postpartum).

Causes of Postpartum Hemorrhage

- Uterine infection

- Abnormal involution of the placenta site

General Signs and Symptoms

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 i- Continuous bleeding which fails to stop after delivery of the placenta.

ii- Shock

iii- Pallore

iv- Fall in blood pressure

v- High Pulse rate

vi- Rest Lessens

2.1.3 Nursing Management

- Good antenatal care and labor.

- Early Identification of women at risk recognition factors

- Accurate history of previous obstetric experience will help to identify high risk

others.

- Getting blood available in high quality during labour.

- Active management of third stage of labor

- Encourage women to always empty their bladder because full bladder delays

second stage of labor.

General Management of Postpartum Hemorrhage

- Call the attention of a doctor

- Stop the bleeding as fast as possible

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 - Resuscitate the patient

- Massage the uterus the uterus expels blood clots.

- However, blood loss of greater than 1000mls or any sign of scorches should

lead to full alert of medical team or experienced RCHP.

- Consider arterial line motoring.

- Oxygen should be given by mask at 8 liters per minute.

- Transfuse cross matched blood

- Monitor vital signs and urinary output

- Ensure bladder is empty

- Give I.V synctocinon 30unit in 500/ms of normal salime.

- Try misoprostol 1000 microgram rectally investigations.

- Through examination of the lower genital tract

- Full blood count estimation

- Clothing factors time should be known this would help to know if it is due

to anticoagulant factors so that all necessary drugs will be prescribed or

corrected.

- If patient delivers at home question will be asked from the relative to

estimate the amount of blood loss.

- All used pads should be kept for doctor for riven.

Risk Factors

Risk factors relating to pregnancy are:

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 1- History of antepartum hemorrhage

2- Placenta previa

3- Previous Postpartum Hemorrhage

4- Pre eclampsia or pregnancy induced hypertension

5- Multiple pregnancies

Risk Factors Relating To Delivery

1. Retained placenta

2. Mediolateral Episiotomy

3. Operative Vaginal delivery

4. Material pyrexia in labor

Predicting who will have Postpartum Hemorrhage based on risk factors is

difficult because two-third (2/3) of women who have Postpartum Hemorrhage

have no risk factors, (JH Piego, 2009). Therefore, all women are considered at

risk, and Postpartum Hemorrhage prevention must incorporated into care

provided at every birth. In addition women should be encouraged to give the birth

with a skilled birth attendance who manage Postpartum Hemorrhage should it

occur, in spite of preventive measures. In a large population based study

significant risk factors identified using multivariable analysis were as follows:

- Retained placenta – 3.5%

- Failure to progress during 2nd stage of labor 34%

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 - Placenta accurate 3.3%

- Instrumental deliver 2.3%

- Large for gestational age newborn 1.9%

- Induction of labor 1.4%

- Augmentation of labor with oxytocic 1.4%

Postpartum Hemorrhage is also associated with obesity in mother. In a study by

Bloomberg maternal obesity and risk of Postpartum Hemorrhage obstetgynecot,

the risk of atomic uterine haemorrhage rapidly increase with increasing body

mass index (13ml), in women with a 13ml over 40 the risk was 5.2% with normal

vaginal delivery and 13.6% with instrumental of Postpartum Hemorrhage.

Complication of Postpartum Hemorrhage

1. Anemia

2. Hypotension

3. Shock

4. Fatigue

5. Death in severe cases

Prevention of Postpartum Hemorrhage

Postpartum Hemorrhage is one of the few obstetrics complications with an

effective preventive intervention. Active management of third stage of labor,

define as the administration of intramuscular oxtocyn, use of controlled

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contraction to expel placenta and fundal massage after delivery of the placenta,

substantially reduces the risk of Postpartum Hemorrhage associated with active

manage of third stage labour (Prendiville, W.J, Elboun D, MC Donald, 2009).

The world Health Organization (WHO, 2012) International Federation of

Gynecologist and obstetricians (FIGO) and the international Confederation of

midwives (ICM) recommended that skilled health attendance provides active

management of third stage of labor for al vaginal births (ICM and FIGO 2007,

ICM and FIGO 2009). In the absence of skilled birth attendance who providers

all the necessary components of active management of their stage of labor

(AMSIL), the WHO, FIGO and ICM recommended that oxytocin is preferred

than other uternotonic drugs where it use is feasible (Mathai, A.M, 2007). Other

preventive measure may either increase women chance of survival or prevent

conditions associated with cause of Postpartum Hemorrhage. These measures

include:

- During antenatal care: Detect and treat anemia.

o Develop a birth preparedness plan to ensure giving birth with a

skilled attendant.

o Distribute Misoprostol to pregnant women during trimester of

pregnancy in case they give birth without a skilled birth attendant.

- During Labor: First and second stage of labor.

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 o Use a pathoghraph to monitor and guide management of labor and

quickly detect unsatisfactory progress.

o Encourage the women to keep her bladder empty

o Limit induction or augmentation use for medical and obstetric

reasons.

o Do not encourage pushing before the cervix is fully dilated.

- Do not use fundal pressure to assist the birth of the badly.

- Perform selective episiotomy for medical and obstetric reason only.

- Assist the women in the controlled delivery of the baby’s head and

shoulder’s to help prevent tears.

- During third stage of labor.

o Provide active management of third stage of labor (single most

effective way of preventing postpartum hemorrhage.

o Do not use fundal pressure to assist they delivery of placenta.

o Do not perform controlled contraction without provide counter

traction to support the uterus.

- After delivery of the placenta.

o Routinely inspect the vulva, vaginal pennum and anus to identify

genital lacerations.

o Evaluate of the uterus is well contracted and massage the uterus at

regular intervals after placenta delivery to keep the uterus we;;

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 contracted and firm (At least every 15mn of the first two hours of

birth).

o Teach the women to massage for vaginal bleeding and uterine

hardness every 15mns for at least first 2hrs.

o Encourage the women to keep her bladder empty during the

immediate postpartum period.

2.4 Theoretical and Conceptual Framework

It is estimated that about 11% of women having given birth, have severe

Postpartum Hemorrhage globally accounting 14million women annually. Even

with the appropriate management, approximately 3% of vaginal deliveries result

in Postpartum Hemorrhage. The incidence is higher in operative deliveries which

are 6.4% increasing section especially when conducted under anesthesia and

3.9% in vaginal deliveries, (Usha nad Indu, 2008). World Health Organization

(WHO, 2008) stated that every year more than 500,000 dire as a result of

complication of pregnancy and child birth suffer serious health problems and a

further 50 million women suffer adverse health consequences which occurred in

developing countries. A women suffering from Postpartum Hemorrhage can die

with 2hrs until she receives immediate and appropriate care (Oladipo, O.T &

Fawole Blum, 2012). World Health Organisation (WHO)| estimated that 150,000

women bleed to death each from Postpartum Hemorrhage with over 99% of these

deaths occurring in developing countries are more than 40 times more likely than

20
women in developing countries to die in child birth (in 61 women and in 2,800

women in developed countries).

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 CHAPTER THREE

RESEARCH METHODOLOGY

3.0 INTRODUCTION

This chapter describes the methods used in carrying out this research which

includes: Research designs, Area of study, Population of the study, sampling

technique, instrument for data collection, validity of instrument, method and data

analysis and ethical consideration.

3.1 RESEARCH DESIGN

A retrospective design was employed in this study on incidence of Postpartum

Hemorrhage among women in postnatal ward at Turai Umar Yar’adua Maternal

and Children Hospital Katsina between April2023 to March, 2024.

3.2 AREA OF STUDY

This research was carried out in Turai Umar Yar’adua Maternal and Children

Hospital Katsina is a private hospital own by a wife of late His excellency the

former president of Nigerian Republic Umaru Musa Yar’adua. The hospital

located at Gidan Dawa Kudu II of Katsina Local Government Area, Katsina State.

Its establish on 2008 and operates on 24hrs basis.

The Turai Umar Yar’adua Maternal and Children Hospital Katsina is licensed

hospital by the Nigeria Ministry of Health with facility code 20/21/1/21/1/0006

22
and registered as secondary health care centre. In gynecology department there

are several activities that are being carried out with the aim taking care of

pregnant women. The Turai Umar Yar’adua Maternal and Children Hospital

Katsina serve on weekdays and weekends.

The hospital has several department that include:

1- General Outpatient Department (GOPD)

2- Medical Record Department

3- Administrative Department

4- Pharmacy Department

5- Immunization Unit

6- Antenatal Care (ANC)

7- Pediatric Unit

8- Theatre Department

9- Maternity Unit

10- Gynecology Ward

11- Family Planning Unit

12- Laboratory Unit

13- Postnatal Unit

14- Prenatal Ward

15- Special Care Baby Unit (SCBU)

16- Radiology Department

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 17- Pediatric Surgical Ward

18- Intensive Care Unit (ICU)

3.3 POPULATION OF THE STUDY

The targeted population are women that had hospital delivery between April,

2023 to March, 2024 in Turai Umar Yar’adua Maternal and Children Hospital

Katsina.

3.4 SAMPLING SIZE AND SAMPLING TECHNIQUE

a total number of about 2783 women had hospital delivery at of which women

had postpartum hemorrhage between April, 2023 to March, 2024.

3.5 INSTRUMENT FOR DATA COLLECTION

The instrument used in this research work is medical record.

3.6 VALIDITY OF THE INSTRUMENT

The records that were collected was presented to the supervisor for scripting and

correction were made before the final approval in other to ensure the validity.

3.7 RELIABILITY OF THE INSTRUMENT

The research establishes the reliability by test and retest method.

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3.8 RECORD OF DATA COLLECTION

Records were collected by the researcher from the record office at Turai Umar

Yar’adua Maternal and Children Hospital Katsina.

3.9 METHOD OF DATA ANALYSIS

The data presented and organized in a frequency distribution table-percentage and

chart were used to analyze the data collected from post record.

3.10 ETHICAL CONSIDERATION

Permission was abstained from the hospital management of Turai Umar Yar’adua

Maternal and Children Hospital Katsina in order to collect the information needed

and the information that was obtained from record office was treated

confidentially.

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 CHAPTER FOUR

DATA PRESENTATION AND ANALYSIS

4.0 introduction

This chapter deals with the presentation and analysis of data obtained in the study.

4.1 HOSPITAL DELIVERY ATTENDANCE AT TURAI YAR’ADUA

MATERNAL AND CHILDREN HOSPITAL IN 2023 APRIL TO 2023

MARCH 2024

Table 1:

S/N MONTHS NO. OF DELIVERIES PERCENTAGE

1. APRIL 110 3.75%
2. MAY 186 6.33%
3. JUNE 239 8.14%
4. JULY 255 8.71%
5. AUGUST 291 9.92%
6. SEPTEMBER 272 9.27%
7. OCTOBER 276 9.40
8. NOVEMBER 187 6.37%
9. DECEMBER 307 10.46%
10. JANUARY 268 9.14%
11. FEBRUARY 117 4.20%
12. MARCH 275 9.37%
Total 2783 100%

The table above shows the number of hospital deliveries in Turai Umar Yar’adua

Maternal and Children Hospital Katsina, from April 2023 to March 2024 with a

total number of 2783. December having the highest percentage (10.46%) with

26
307 number of deliveries while April has the lowest percentage (3.75%) with 110

deliveries.

4.2 CASES OF POSTPARTUM HEMORRHAGE IN 2023 APRIL TO

MARCH 2024

Table 2:

S/N MONTHS CASES OF PPH PERCENTAGE

1. APRIL 8 9.00%
2. MAY 11 12.36%
3. JUNE 2 2.24%
4. JULY 13 14.61%
5. AUGUST 12 13.48%
6. SEPTEMBER 4 4.49%
7. OCTOBER 7 7.86%
8. NOVEMBER 3 3.37%
9. DECEMBER 6 6.74%
10. JANUARY 10 11.24%
11. FEBRUARY 8 9.00%
12. MARCH 5 5.61%
Total 89 100%

The table above shows the number of cases of postpartum hemorrhage in April

2023 to March 2024 where there in highest number of postpartum hemorrhage in

July with 13 cases (14.61) while June has the lowest with 2 (2.24%).

27
CHART 1: INCIDENCE OF POSTPARTUM HEMORRHAGE IN TURAI

YAR’ADUA MATERNAL AND CHILDREN HOSPITAL KATSINA

Chart Title
350

300

250

200

150

100

50

NUMBER OF DELIVERIES PERCENTGAE

Chart 1: shows the incidence of postpartum hemorrhage in Turai Umar Yar’adua

Maternal and Children Hospital Katsina from April 2023 to March 2024. The

incidence was 40.09%

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 CHAPTER FIVE:
SUMMARY, CONCLUSION AND RECOMMENDATION
6.0 Introduction

This chapter basically presents the summary of the findings, conclusion drown

and recommendations made by the researcher.

4.1 Summary

Considering the research work undertaken by the researcher in the previous

chapters, different items were discussed which well be summarized below:

In chapter one, items like background of the study, statement of the

problem, objectives of the study, research questions, significance of the study and

scope delamination of the study and operational definition of terms were all

discussed extensively by the researcher in the work.

In chapter two, , literature reviewed by the researcher in the research

projects under taken.

Therefore, in Chapter Three, items such as the research design, population

and of the study, sample size and sample technique, data collection instruments,

scoring procedure for data collection, and procedure for data analysis were all

elaborated in the research work. Meanwhile in the Chapter four, the various

information obtained from different participants were logically presented into the

tables, analyzed them, answer to questions, hypothesis testing, summary of

29
findings as well as discussions of findings by the researcher all in the work

undertaken.

6.2 Conclusion

In conclusion with reference to the researcher’s general expression of overview

points through this research work executed. I hereby describing the assessment

of postpartum hemorrhage in Turai Umar Yar’adua Maternal and Children

Hospital Katsina. Thus, by knowing and contemplating the various existence of

regularities and natural phenomena, it will cause have caution, awareness, and

precautions towards pregnant women and child health within the research scope

and Nigeria in general.

In addition, Nigeria is the most populous country in Africa and the seventh

most populous in the world with an estimated population of 214.4 billion in 2020

Newborn deaths are a significant contributor to Under-five Mortality Rate, it

accounts for 45% of U5MR globally and 32% in Nigeria.21 The neonatal

mortality rate had increased from 37 to 39 per 1000 live birth (NDHS 2018).

Maternal mortality is also high in the country, especially in the northern region

with over 1000 maternal deaths per 100,000 live births. The country’s failure to

reduce both maternal and neonatal Mortality Rates will hamper the attainment of

the SDG 3 targets.

By the preventing the main causes of maternal death will require a

spectrum of services including prenatal and delivery care, family planning, and

30
treatment for the complications of unsafe abortion (with provision of safe

abortion depending on the law). Provision of comprehensive and integrated care

increases the chance of achievement of the objectives of maternal health care.

The key in controlling and restoring women health in pregnancy is ANC is

an important factor in the reduction of both maternal and neonatal mortalities.

Antenatal care is a major component of reproductive health care and consists of

prenatal, natal, and postnatal care which aims at reducing infant and maternal

morbidity and mortality through early detection of complications and prompt

treatment, prevention of diseases, birth preparedness and health promotion.

The result findings shows that reducing maternal mortality rates are what

extent postpartum hemorrhage in Turai Umar Yar’adua Maternal and Children

Hospital Katsina with 50.93%.

6.3 Recommendation

From the findings, recorded by this research the following recommendations are

hereby presented as follows;

1. Ministry of Health should provide a services in both public and private

health facilities and through community-based distribution networks an

integrated approach ensuring continuity of care through pregnancy,

delivery and postpartum period is essential.

31
2. Government should ensure plans to improve healthcare services for

maternal and new-born by equipping health facilities with adequate

facilities, commodities, and manpower for effective maternal and newborn

care service delivery.

3. Institutions/College should offered a counselling by health care students to

be trained to respect clients concerns and sensibilities.

4. More so, the parent/husband should be guide their children and showing

them the basic knowledge on maternal and child health’s .

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