Evaluating the active management of third stage of labour as a strategy to reduce the incidence of postpartum haemorrhage in Kyrgyzstan: a retrospective cross-sectional study
(2014) MPHN11 20131Social Medicine and Global Health
- Abstract
- Background: Maternal mortality is still a key issue in public health. Postpartum haemorrhage (PPH) is one of the main direct causes of maternal mortality in many countries around the world, including Kyrgyzstan where approximately half of all maternal deaths are due to this complication. Maternal mortality caused by PPH can be prevented through cost-effective interventions including active management of the third stage of labour (AMTSL).
Aim: The aim of this study is to assess the occurrence of primary postpartum haemorrhage before and after the implementation of AMTSL and external aorta compression in a maternity hospital in Kyrgyzstan and to evaluate among patients with PPH those factors associated with increased or reduced severe... (More) - Background: Maternal mortality is still a key issue in public health. Postpartum haemorrhage (PPH) is one of the main direct causes of maternal mortality in many countries around the world, including Kyrgyzstan where approximately half of all maternal deaths are due to this complication. Maternal mortality caused by PPH can be prevented through cost-effective interventions including active management of the third stage of labour (AMTSL).
Aim: The aim of this study is to assess the occurrence of primary postpartum haemorrhage before and after the implementation of AMTSL and external aorta compression in a maternity hospital in Kyrgyzstan and to evaluate among patients with PPH those factors associated with increased or reduced severe blood loss.
Methods: Rates of PPH were examined during the period 2006-2010. A retrospective analysis of 274 PPH cases was also conducted. The data on obstetric history, independent and outcome variables were collected from medical records. Comparisons were made between women with PPH who received expectant (EMTSL) and active management of third stage of labour. The dependent variable was volume of blood loss. Logistic regression was used to estimate odds ratios (OR) for severe blood loss (>1000 ml) among patients with PPH that received AMTSL compared to patients that received EMTSL.
Results: Despite the implementation of AMTSL, the incidence rate of PPH significantly increased between the period of January 2006 - November 2008 compared to the period December 2008- end -December 2010 (p- value = 0.001, Fisher´s exact –test). Anaemia at the last ANC visit significantly increased the likelihood of severe blood loss among patients with PPH (OR 1.98, 95% CI: 1.10 to 3.71, p-value = 0.03). History of PPH as well as the presence of an obstetrician/gynaecologist (OBG) as a birth attendant was significantly associated with reduced likelihood of severe blood loss (OR 0.13, 95% CI: 0.04 to 0.43, p-value = 0.001 and OR 0.51, 95% CI: 0.31 to 0.99, p- value = 0.046 respectively). AMTSL was significantly associated with decreased likelihood of severe blood loss among patients with PPH (OR= 0.43, 95% CI: 0.22-0.86, p- value = 0.017), when adjusting for various confounders.
Conclusions: This study identified several factors that may influence the risk of severe blood loss among patients with PPH. AMTSL was identified as a good method for reducing severe blood loss and may be an important step towards reducing maternal mortality. However, since the occurrence of PPH increased over time, the implementation of AMTSL may not be sufficient for reducing the
occurrence of PPH, or alternatively, other factors may contribute to the increased rates of PPH observed. (Less)
Please use this url to cite or link to this publication:
http://lup.lub.lu.se/student-papers/record/4529895
- author
- Tashbulatova, Naila LU
- supervisor
- organization
- course
- MPHN11 20131
- year
- 2014
- type
- H2 - Master's Degree (Two Years)
- subject
- keywords
- Active management of third stage of labour, expectant management of third stage of labour, postpartum haemorrhage, external compression of aorta, Kyrgyzstan.
- language
- English
- id
- 4529895
- date added to LUP
- 2014-07-14 10:38:58
- date last changed
- 2014-09-04 08:34:31
@misc{4529895,
abstract = {{Background: Maternal mortality is still a key issue in public health. Postpartum haemorrhage (PPH) is one of the main direct causes of maternal mortality in many countries around the world, including Kyrgyzstan where approximately half of all maternal deaths are due to this complication. Maternal mortality caused by PPH can be prevented through cost-effective interventions including active management of the third stage of labour (AMTSL).
Aim: The aim of this study is to assess the occurrence of primary postpartum haemorrhage before and after the implementation of AMTSL and external aorta compression in a maternity hospital in Kyrgyzstan and to evaluate among patients with PPH those factors associated with increased or reduced severe blood loss.
Methods: Rates of PPH were examined during the period 2006-2010. A retrospective analysis of 274 PPH cases was also conducted. The data on obstetric history, independent and outcome variables were collected from medical records. Comparisons were made between women with PPH who received expectant (EMTSL) and active management of third stage of labour. The dependent variable was volume of blood loss. Logistic regression was used to estimate odds ratios (OR) for severe blood loss (>1000 ml) among patients with PPH that received AMTSL compared to patients that received EMTSL.
Results: Despite the implementation of AMTSL, the incidence rate of PPH significantly increased between the period of January 2006 - November 2008 compared to the period December 2008- end -December 2010 (p- value = 0.001, Fisher´s exact –test). Anaemia at the last ANC visit significantly increased the likelihood of severe blood loss among patients with PPH (OR 1.98, 95% CI: 1.10 to 3.71, p-value = 0.03). History of PPH as well as the presence of an obstetrician/gynaecologist (OBG) as a birth attendant was significantly associated with reduced likelihood of severe blood loss (OR 0.13, 95% CI: 0.04 to 0.43, p-value = 0.001 and OR 0.51, 95% CI: 0.31 to 0.99, p- value = 0.046 respectively). AMTSL was significantly associated with decreased likelihood of severe blood loss among patients with PPH (OR= 0.43, 95% CI: 0.22-0.86, p- value = 0.017), when adjusting for various confounders.
Conclusions: This study identified several factors that may influence the risk of severe blood loss among patients with PPH. AMTSL was identified as a good method for reducing severe blood loss and may be an important step towards reducing maternal mortality. However, since the occurrence of PPH increased over time, the implementation of AMTSL may not be sufficient for reducing the
occurrence of PPH, or alternatively, other factors may contribute to the increased rates of PPH observed.}},
author = {{Tashbulatova, Naila}},
language = {{eng}},
note = {{Student Paper}},
title = {{Evaluating the active management of third stage of labour as a strategy to reduce the incidence of postpartum haemorrhage in Kyrgyzstan: a retrospective cross-sectional study}},
year = {{2014}},
}