![]() ![]() It is known that PPH is the consequence of several different factors that can occur in isolation or combination, such as: uterine atony, retained placental tissue, genital tract trauma and coagulation dysfunction (the ‘4Ts’ mnemonic: tone, tissue, trauma, and thrombin). Recent studies have shown an increasing trend in PPH, but the causes for this increase are still uncertain. Consequently, PPH has received increasing attention as a quality indicator for obstetric care. The World Health Organization works to contribute to the reduction of maternal mortality by increasing research evidence, providing evidence-based clinical and programmatic guidance. WHO indicates that most maternal deaths resulting from PPH occur within the first 24 hours postpartum and are preventable and manageable if appropriate and effective resources are readily available. Therefore, the definition of PPH in the context of this study also relates to WHO near-miss definition: “a woman who nearly died but survived a complication that occurred during pregnancy, childbirth or within 42 days of termination of pregnancy”. Women who experience severe acute complications like the case of PPH share many pathological and contextual factors in relation to their condition. The later definition is applied in the present study considering local context of Low and Middle income countries including Rwanda. The World Health Organization, defines PPH as blood loss of 500 ml or more following a normal vaginal delivery (NVD) or 1000 ml or more following a caesarean section within 24 hours after birth. In recent past, the “reVITALize program of the American College of Obstetricians and Gynecologists’ (ACOG)”, which aims to standardize clinical obstetric terminologies, defined PPH as an increasing blood loss of 1,000 mL or blood loss followed by signs and symptoms of hypovolemia within 24 hours after birth. The definition of Primary postpartum haemorrhage (PPH) as a major cause of maternal mortality and severe morbidity has been evolving over time to help identify the people most likely to have morbidity and hence adopt timely health interventions. Complications, such as maternal obesity, curettage in previous pregnancy, hypertensive diseases, haemoglobin (Hb) level less than or equal to 10 g/dL may exist before pregnancy and may pose problems during pregnancy leading to PPH, especially if not managed as part of the woman’s care. ![]() Most maternal complications develop during pregnancy and many are preventable or treatable. Reduction of maternal mortality has long been a global health priority, and a target in the United Nations (UN) 2030 agenda for Sustainable Development Goals is to reduce the global MMR to less than 70 per 100,000 live births. The maternal mortality ratio (MMR) in Rwanda is reported to be 203/100,000 live births. The vast majority of these deaths (94%) occurred in low-resource settings, and most could have been prevented. According to the World Health Organization (WHO), approximately 295 000 women died during pregnancy or after childbirth in 2017. ![]() ![]() Maternal mortality remains unacceptably high worldwide. ![]()
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