CHAPTER FIVE

5.0 Introduction

This chapter deals with the identification of key findings, implication of the findings

with literature support, alignment of the study with the previous studies, implication

of findings to midwifery, limitations of the study, summary, conclusion,

recommendation and suggestions for further studies.

51. IDENTIFICATION OF FINDINGS

36 questionnaires were distributed and 34 were retrieved for analysis. The following

are the major findings of the study majority of the respondents were between the ages

of 26-35years (44.1%), Majority of the respondent (91.1%) were married, Majority of

the respondent (79.4%) were female, Majority of the respondents were Nurses

(55.9%),Majority cases of postpartum hemorrhage were seen often with (47.0%)

Majority of the respondents agreed that cases of postpartum

hemorrhage are often, and it is caused by mismanagement of third stage of labour,

retained placenta/fragment and also atonic uterus(67.6%), Majority says Previous

history of postpartum hemorrhage can leads to its occurrence in subsequent deliveries

(70. 6%),Majority says Updated knowledge of the midwives is needed in order to

manage third stage of labour effectively there by reducing prevalence of postpartum

hemorrhage (97.0%), Majority says Hospital delivery can help in reducing the

incidence of postpartum hemorrhage (94.0%). Majority says The category of mothers

mostly affected with postpartum hemorrhage are grand multifarious (67.6%),

Majority says Commonly ocurring complication of postpartum hemorrhage is Anemia

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(64.7%), Majority says Effective antenatal care have impact on detection of those at

risk of postpartum hemorrhage (91.2%). Majority says postpartum hemorrhage can be

prevented through good practice of active management of third stage of labour

(50.0%), Majority says control cord traction, use of uterotonic and massaging of the

uterus have good effect on prevention of postpartum hemorrhage (100%). Majority

says The practice of aseptic technique in the delivery room prevent postpartum

hemorrhage (85.3%)

Majority says Avoidance of forceps and traumatic instrumental deliveries prevent

postpartum hemorrhage (91.2%), Majority says Effective management of third stage

of labour prevent the occurrence of postpartum hemorrhage. Mismanagement of third

stage of labour leads to postpartum hemorrhage (100%). Majority says Ensuring

contracted uterus there by frequently massaging of the uterus following second stage

of labour is a major aspect in prevention of postpartum hemorrhage (94.1%), Majority

says administration of an oxytocic drug after delivery by the midwife help in

contracting the uterus there by preventing postpartum hemorrhage (97.0%), Majority

says administration of an oxytocic drug aid in contracting the uterus there by

managing the postpartum hemorrhage (100%). Majority says Midwives estimate

blood loss in the management of postpartum hemorrhage (82.4%), Majority says

Administration of misoprostol contract the uterus thereby managing postpartum

hemorrhage (100%). Majority says Manual removal of the placenta is the major

aspect in management of postpartum hemorrhage caused by placenta/fragment

(85.3.%), Majority says Secondary postpartum hemorrhage as a result of sepsis is

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managed by antibiotic therapy (100%), Majority says There is need for the use of

antishock garment in management of postpartum hemorrhage (79.4%).

5.2 IMPLICATION OF THE FINDINGS WITH LITERATURE SUPPORT

This study was conducted on the practice of Nurses on prevention and

management/Control of postpartum hemorrhage. According to the findings, Majority

of the respondents have knowledge on Postpartum Haemorrhage, in literature review,

postpartum hemorrhage is seen as severe bleeding from the genital tract in excess

500mls at any time following the birth of the fetus up to 12 weeks postnatally. All

health care providers providing maternity care require a range of life - saving skills to

enable them to make a significant contribution to reducing Postpartum hemorrhage,

maternal death and to promote safe motherhood . American Nurses Association.

(A.N.A, 2014).

Also, Majority says postpartum hemorrhage can be prevented through good practice

of active management of third stage of labour (50%%) and use of uterotonics, in

literature review, WHO 2017 says, the guidelines development, group consideration

of the use of uterotonic as the main intervention within the active management of

third stage of labour and also for reducing blood loss during the third stage of labour

in cesarian section. Cord traction is recommended in preference to manual removal

when assisting placental delivery in cesarian section.

Also, Majority of the respondents says postpartum hemorrhage can be managed by

estimate blood loss in the management of postpartum hemonhage and Administration

of misoprostol contract the uterus thereby managing postpartum hemorrhage (100%).

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In literature review Glover (2014) says, accuracy of estimated blood loss been

practiced by the midwives in the prevention of Posparum hemorrhage. A study

conducted in Austalia identified the underestimation of blood loss by 30-50% of

midwives and recommended that estimation of blood loss should be included in

training curriculum in obstetrics.

5.3 ALIGNMENT OF THE STUDY WITH THE PREVIOUS STUDIES.

Table 4.2 shows that Majority says Updated knowledge of the midwives is needed in

order to manage third stage of labour effectively there by reducing prevalence of

postpartum haemorrhage (97.0%) while least (3.0%) of the respondent view it of no

need this is align with another research conducted by Rehel(2014), the results reveals

89% of health workers are aware of PHI While 11% are not aware of PPH. Table 4.3

shows Majority says postpartum haemorrahage can be prevented through good

practice of active management of third stage of labour (50.0%) Which is inline with

another research conducted by Vaate(2015),on the assessment of PPH, the result

shows that 20% of respondant mentioned good ANC as a preventive measure of PPH

whole 80% mentioned practice of active management of third stage of labour.

Table 4.4 shows that Majority says Administration of misoprostol contract the uterus

thereby managing postpartum haemorrhage (100%) which makes it align with another

research conducted by Vaate(2015)on the Assessment of PPH, The result shows that

60% of respondant mentioned administration of misoprostol as management of PPH

while 40% mentioned active management of third stage of labour

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5.4 IMPLICATION OF FINDINGS TO MIDWIFERY PRACTICE.

The study was conducted on the nursing practice on prevention and management of

postpartum hemorrhage in Maternal and children hospital Malumfashi. The research

work will expose the midwife on the subject matter, preventive and management

strategies on postpartum hemorrhage. It will also assist the midwives in updating their

knowledge for improving comprehensive midwifery approach towards identifying the

risk factors and preventing complications associated with Postpartum hemorrhage. To

be also alerted on the dangers of postpartum hemorhage in order to reduce maternal

morbidity, mortality and complications associated with postpartum hemorrhage. The

study wil improve more knowledge of the health care workers on the ways of

preventing the reourrence of postpartum hemorrhage and managing it's complications.

5.5 LIMITATIONS

poor compliance of some health care workers to participate in the study due to

shortage of manpower and the workers are busy with patients at the ward was

encountered during the research.

5.6 SUMMARY

This research work was on nursing practice on prevention and management of

postpartum hemorrhage conducted at Maternal and Children hospital malumfashi 36

questionnaires were distributed and 34 were retrieved.

It was found out that health care workers have updated knowledge on prevention and

management of postpartum hemorrhage as they know it been very vital.

Mismanagement of third stage of labour, retained placenta fragment and atonic uterus

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are found to be the major causes of postpartum hemorrhage in this facility and it

mostly affect grand multifarious and multifarious women.

Postpartum hemorrhage can be prevented and managed through updated knowledge

of midwives, practice of good antenatal care, therefore; by explaining the importance

of hospital delivery, practice of active management of third stage of labour, avoidance

of forceps and traumatic instrumental deliveries, detection of those at risk and

managed through administration of oxytoc drug or misoprostol and use of antishock

garment,Prompt treatment there by avoiding complication.

Midwives should play a vital role in providing serious attention to women on labour

especially on the third stage of labour to ensure that adequate precautions have been

put into practice to see that patient does not develop postpartum hemorrhage.

5.7 CONCLUSION

Despite health care worker's knowledge on postpartum hemorrhage, Postpartum

hemorrhage occurs often in Maternal and children hospital mostly among multiparous

and grand multiparous women, pregnant women should be sensitized on the

prevention and management of post-partum hemorrhage and nurses should be updated

on postpartum hemorrhage.

5.8 RECOMMENDATIONS.

Based on the findings, discussion and implications of the study, the findings

recommendations are made.

Workshops, seminars should be part of Government schedule in order to update

nurses with current practice and therapeutic measures to be used in prevention and

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management of postpartum hemorrhage and its complication.

The State Government all over the Federation should provide effective maternity

services that will reach out both the urban and rural areas so as to enable the Nurses

render effective maternity care to clients.

Antenatal cares should be intensified within the hospital setting not only providing

care for booked but also ensuring that they have access to all the available facilities to

maintain health, have normal pregnancy, labour and delivery.

Nurses should be strict to the active management of third stage of labour there by

preventing the occurrence of postpartum hemorrhage.

Proper records keeping on incidence of postpartum hemorrhage to know when it is of

increase or decrease in the incidence in maternity unit of Maternal and children

hospital malumfashi.

Refresher courses where nurses - midwives and other health professionals will be

trained and retrained on the ways used in the prevention and management of

postpartum hemorrhage should be periodically organized.

Provision and training of nurses on the use of anti-shock garment.

5.9 SUGGESTIONS FOR FURTHER STUDIES

Further studies should be carried out on assessment of nurses practice on prevention

and management of post-partum hemorrhage among health care workers.