DOWNLOAD FULL TEXT PDF 

Prevalence and Associated Risk Factors of Ante-Partum Hemorrhage among Pregnant Women Attending Antenatal Clinic at Jinja Regional Referral Hospital Jinja City.

Edeket John Paul

Faculty of Clinical Medicine and Dentistry Kampala International University Western Campus Uganda.

ABSTRACT

This study was carried out at Jinja Regional Referral Hospital to determine the Prevalence and associated risk factors of antepartum haemorrhage among pregnant women attending antenatal clinics.  The researcher used simple random sampling to select her Mothers to participate in the study. The mothers that participated in this study were 15 years and above and had genuine and mature answers according to the Researcher’s view of the study. The questionnaires were constructed to obtain information on the prevalence and associated risk factors of antepartum haemorrhage among pregnant women attending antenatal clinics. The researcher analyzed the quantitative data that was collected using questionnaires and analyzed using SPSS. It was expressed in terms of frequencies and percentages, which helped the researcher to show the distribution of respondents on each of the independent and dependent variables. The majority of the mothers were of the age group (26-30) years accounting for 33.3%, and the least were both (30-35) years and above 35 years accounting for 18.8%. 91.7% of the respondents were married, 4.2% were divorced and 2.1% were widows. The majority were peasants accounting for 41.7%, followed by employed ones at 31.2%, unemployed were 25.0% and lastly unspecified at 2.1%. These respondents were majorly of college/tertiary level of education accounting for 37.5%, followed by uneducated at 25.0%, secondary level at 22.9%, primary level were 10.9% and lastly post-graduate level at 2.1%. The majority of the respondents were not having PV bleeding which is 79.1% and those with PV bleeding were only 18.8% of the respondents. For those with PV bleeding it mainly lasted for 1 day with 6.2% of the respondents. It has found that APH was common in mothers in the age group of (20-30) years and factors which increased APH among women that participated in the study included the following factors smoking or chewing tobacco, number of deliverance, history of operations on the uterus, time interval to get another pregnancy, history of trauma. This made these major risk factors of APH. There the research recommended the government, sub-county, district and health workers to educate mothers on the risk factors of APH especially those above.

Keywords: Antepartum haemorrhage, Pregnant women, Antenatal clinic, PV bleeding, Mothers. 

INTRODUCTION

Antepartum haemorrhage is listed as a maternal complication in 15.1% of fetal and 7.1% of early newborn deaths worldwide [1]. APH is responsible for an estimated 6.5% of maternal deaths worldwide [2]. Up to 1/5 of all very preterm babies are born in association with APH [3]. APH complicates 2-5% of pregnancies and is defined as bleeding into or from the genital tract after the 20th week of pregnancy [4]. APH is a serious condition which accounts for a high percentage of maternal and neonatal morbidity and mortality. Identifiable causes of APH are recognized in 50% of cases, and in the other 50% of cases, the cause for the APH is indeterminate or unknown [5]. Blood loss is often underestimated and the amount visible may only be a portion of the total volume of the hemorrhage. There were 4 deaths from APH in the more recent report [6]. In the 2005–07 report of the Confidential Enquiries into Maternal Deaths in South Africa, obstetric haemorrhage was the third most common cause of death accounting for 12.4% of all deaths; there were 108 deaths from APH and 74 of these (68.5%) were considered to be clearly avoidable. Haemorrhage emerges as the major cause of severe maternal morbidity in almost all ‘near miss-audits in both developed and developing countries [7]. Between January 1 and December 31, 2013, a total of 3,854 women gave birth in JUSH Ethiopia. One hundred ninety-five of them were diagnosed to have APH showing a cumulative incidence of 5.1% in 2013. The average age of the women was 26.6 years with a standard deviation of 5.9 years. Two third of the mothers were in the age range of 21 and 34. Abruptio placentae and placenta previa were the major causes of APH established as final diagnoses in 127 (65.1%) and 52 (26.7%) APH patients, respectively. Other causes including leech infestation and unknown causes accounted for 16 (8.2%) of the cases. The incidence of abruptio placentae and placenta previa was 3.3% and 1.4% among mothers who gave birth in JUSH in 2013 [8]. In the study of patient characteristics and outcomes in antepartum haemorrhage due to placenta previa and abruption placenta at the university teaching hospital, Lusaka, Zambia, a total of 73 consecutive patients were recruited into the study from October 2013 to January 2014. One was excluded because she was recruited twice. Of the 72 participants who had APH, 55.6% were due to placenta praevia whereas 44.4% were due to abruption of the placenta. During the two-year study period involving 124 women with a diagnosis of APH, the incidence of APH was 1.311 %. Placenta previa is 0.835% and that of abruptio placentae is 0.476%. The incidence of APH was 39% in the age group 26 – 30 years and 22% in age more than 30 years. Seventy-two per cent of cases of APH were multigravida. 38% of whom were gravida 3 & gravid 4. Fifty-seven cases (46%) had a history of previous uterine surgery. Thirty-three out of 45 cases of abruption (73%) are associated with pregnancy-induced hypertension. Out of the total number of women presenting with APH (124), 75 had preterm delivery (60.5%) Out of 124 cases who presented with APH, 112 patients (90.32%) delivered by Caesarean section and the remaining 12 (9.68%) delivered vaginally. In the present study, there were no mortalities. Thirty-six per cent were complicated by PPH. Out of the total number of women presenting with APH (124), 92 required blood and blood products transfusion (75%). For control of PPH, other operative interventions such as vessel ligation, placental bed suturing, and packing of the lower uterine segment were used.

DISCUSSION

Social Demographic Findings

In this study majority of the respondents were of the age group (26-30) years accounting for 33.3%, followed by (21-25) years accounting for 27.1%, and both (30-35) years and above 35 years accounted for for 18.8%. 91.7% of the respondents were married, 4.2% were divorced and 2.1% were widows. The majority were peasants accounting for 41.7%, followed by employed ones at 31.2%, unemployed were 25.0% and lastly unspecified at 2.1%. These respondents were major in college/tertiary level of education accounting for 37.5%, followed by uneducated at 25.0%, secondary level at 22.9%, primary level were 10.9% and lastly post-graduate level at 2.1%. A prospective study on birth outcome and prevalence of postpartum morbidity among pregnant women who attended antenatal care in Gondar town, North West Ethiopia by Town, 2014 showed similar findings where the majority of the respondents were in the age group of (20-24) years and (25-29) years accounting to 38.91% and 33.00% respectively. In this same study, the majority were of a secondary level accounting for 48.28% of the respondents and 92.61 were married. These two studies show related information on social demographic findings.

More studies have shown the relationship between social demographic factors with APH which was the majority of the parturients, 45 (39.8%) were in age between 25 and 29 years and 98.2% were married according to [17]. About 70% of the respondents are in the 20-34 age group, slightly less than a quarter are 35 years old or above, while only 7.4% are in the teen years of 15 to 19 years. According to [18], the majority (87.4%) of the women are resident in rural areas. In terms of educational attainment, the bulk of the women (61%) have only primary education, while more than a fifth of the women (23%) have no formal education; only 16% have secondary or more education. All these studies reveal that respondents are mainly in the age group of (20-30) years and were married.

Discussion of Risk Factors of APH

This study reveals that factors which increased APH among women that participated in the study included the following factors smoking or chewing tobacco, number of deliverance, history of operations on the uterus, time interval to get another pregnancy, and history of trauma. This made these major risk factors of APH. The more a mother increase in having these factors the ranger the risk of getting PV bleeding (APH). This study’s “history of the caesarian section” reflected the decreased rate of APH (PV bleeding) which agrees with [17], where a caesarean section was generally accepted as a safe alternative mode of delivery in developed countries by both patients and caregivers. However [19], [20], gave a strong aversion to the procedure by women in sub-Saharan Africa but antepartum haemorrhage is one of the major indications for caesarean section. [21], [22] said that even though it is safe, it is not without important risks such as increased mean blood loss, febrile illness, thromboembolic disease, infection and a mortality risk of up to five times that of vaginal delivery. Another agreement with [17], is the history of anaemia which also happened to the factor with the highest chances of increased APH (PV bleeding) which was further reflected by another study which showed a higher prevalence of anaemia among the parturients with antepartum haemorrhage. This study reveals that factors like taking alcohol or miss using drugs, history of hypertension with current pregnancy, and history of serious medical condition showed less impact on increasing PV bleeding (APH) among mothers [23], [24]-[26], said that “though several studies have shown a relationship between haemoglobin levels above 13.2g/dl and below 10.4g/dl to be associated with adverse pregnancy outcomes such as stillbirths,pregnancy-induced hypertension, intrauterine growth restriction, low birth weight, preterm delivery, perinatal death.”

CONCLUSION

In conclusion, this study has found that APH was common in mothers within the age group of (20-30) years and factors which increased APH among women that participated in the study included the following factors smoking or chewing tobacco, number of deliverance, history of operations on the uterus, time interval to get another pregnancy, history of trauma. This made these major risk factors of APH. There I recommended the government, sub-county, district and health workers to educate mothers on the risk factors of APH especially those above.

REFERENCES

1. Vogel, J. P et al. (2013). Maternal complications and perinatal mortality: findings of the World Health Organization multicounty survey on maternal and newborn health. BJOG. 1:76-88.
2. Say, L. et al. (2014). Global causes of maternal death: a WHO systematic analysis. Lancet Global Health 2: e323-33.
3. Adekanle, D. A., Adeyemi, A. S., & Fadero, F. F. (2011). Antepartum haemorrhage and pregnancy outcome in LAUTECH Teaching Hospital, south western Nigeria.2:1243–7.
4. Thorogood, C., & Donaldson, C. (2010). Challenges in pregnancy. Midwifery preparation for practice.2nd ed. Sydney: Churchill Livingstone; 2010. p. 754-817.
5. Hospital, G., Ra, A., Tb, E., & Fy, T. (2016). Journal of Women’s Health Care Prevalence and Associated Factors of Adverse Birth Outcomes among Women Attended Maternity Ward at Negest Elene Mohammed Memorial. 5(4):3–7.
6. Cantwell, R., Clutton –Brock, T., Cooper, G., Dawson, A., Drife, J., & Garrod, D. (2006). Saving Mothers’ Lives: Reviewing maternal deaths to make motherhood safer. The eighth.
7. Kalule-Sabiti, I., Yaw Amoateng, A., &, N. K. (2013) ‘The Effect of Sociodemographic Factors on the Utilization of Maternal Health Care Services in Uganda’, Open Science Repository Sociology, Online (1), p. e70081995. doi: 10.7392/openaccess.70081995.
8. Chufamo, N., Segni, H., & Alemayehu, Y. K. (2015). Incidence, Contributing Factors and Outcomes of Antepartum Hemorrhage in Jimma University Specialized Hospital, Southwest Ethiopia. 3(4):153–9.
9. Interparliamentary-Union. (2015). Maternal and Child Health: Uganda Experiences Slow Progress in Maternal Health. Partnersh Matern newborn child Heal Rev Uganda.
10. Elizabeth, L. M., Jennifer, B., Lockwood, J. B. Maternal health supplies in Uganda. Soc Sci. 1986; 11(No. 11):755–61.
11. Tikkanen, M., Nuutila, M., Hiilesmaa, V., & Paavonen, J. (2006). Ylikorkala, O. Clinical presentation and risk factors of placental abruption. Acta Obstet Gynecol Scand. 85:700–5.
12. Calleja-Agius, J., Custo, R., Brincat, M., & Calleja, N. (2011). Placental abruption and placenta praevia. Krishna A, Chandraharan E. Management of Massive Obstetric Haemorrhage. Current Women’s Health Review. (7):136-42.
13. Walfish, M., Neuman, A., & Wlody, D. (2009). Maternal haemorrhage. Br J Anaesthesia 103: i47–i56.
14. Journal, G. I. (2015). Antepartum Haemorrhage : Causes & Its Effects on Mother and Child : An Evaluation. 3(1):1–
15. Facts, Q. (2017). Jhpiego in Uganda;
16. Ugwu, C. N., & Eze, V. H. U. (2023). Qualitative Research. IDOSR of Computer and Applied Science, 8(1), 20–35.
17. Mulegi, Tom. (2022). An Overview of Performance of Health Workers in Uganda. IDOSR Journal of Humanities and Social Sciences. 7(1), 113-124.
18. Harunah, Ssenyonga. (2023). Assessments of Puerperal Sepsis in Women at Kampala International University Teaching Hospital Western Campus, Uganda. IDOSR Journal of Biochemistry, Biotechnology and Allied Fields. 8(1), 42-52.
19. Emmanuel, Ifeanyi Obeagu, Benjamin Kigabo Ndakize, Okechukwu Paul-Chima Obeagu, Getrude Uzoma, Ugwu, Kazibwe Sophia. (2023). Neonatal Sepsis: Haematological Perspectives. IDOSR Journal of Scientific Research. 8(2), 161-166.
20. Felix Ayen. (2023). Assessment of factors associated with burden of Puerperal Sepsis in maternity women at Ishaka Adventist Hospital Bushenyi District. INOSR Experimental Sciences. 11(2), 32-41.
21. Mercy Mamman Maizanko. (2023). Knowledge and Practices on Infection Control among Health Workers in Jinja Regional Referral Hospital. NEWPORT International Journal of Scientific and Experimental Sciences. 3(2), 141-148. .
22. Rebecca Namuddu. (2023). Attitudes and Practices of Mothers towards Neonatal Umbilical Cord Sepsis in Maternity Ward of Kitagata Hospital, Sheema District. INOSR Scientific Research. 9(2), 1-14.
23. Muhindo Emmanuel. (2023). Knowledge Attitude and Practices of Health Workers on Puerperal Sepsis Preventions at Bundibugyo Hospital Bundibugyo District. Newport International Journal of Scientific and Experimental Sciences (NIJSES). 3(3), 68-88.
24. Jilda Martha Piranok. (2023). Evaluation of factors that contributes to post-partum haemorrhage in Pregnant Women at KIU-TH. IDOSR Journal of Experimental Sciences. 9(2), 64-77.
25. Joan Namagembe. (2023). Assessment of Incidence and Factors associated with Postpartum Hemorrhage among Women delivering at Kampala International University Teaching Hospital Bushenyi District. IDOSR Journal of Applied Sciences. 8(2), 29-38.
26. Micheal Ssebintu. (2023). Incidence of Wound Sepsis and related Factors in Post-Operative Patients in Kampala International University Teaching Hospital Ishaka Bushenyi-Western Uganda. INOSR Experimental Sciences. 11(2), 122-133.

CITE AS: Edeket John Paul (2023). Prevalence and Associated Risk Factors of Ante-Partum Hemorrhage among Pregnant Women Attending Antenatal Clinic at Jinja Regional Referral Hospital Jinja City. IDOSR JOURNAL OF SCIENTIFIC RESEARCH 8(3) 44-58.https://doi.org/10.59298/IDOSR JSR /2023/00.4.6000

DOWNLOAD FULL TEXT PDF