A Retrospective Study Assessing the Causes of Postpartum Hemorrhage in Women Admitted to Kisumueast District Hospital Between January – June 2014

Contents

DECLARATION........................................................................................................................................ iv

CERTIFICATION...................................................................................................................................... v

DEDICATION............................................................................................................................................ vi

ACKNOWLEDGEMENT........................................................................................................................ vii

LIST OF ABBREVIATIONS/ ACRONYMS........................................................................................ viii

ABSTRACT................................................................................................................................................ ix

CHAPTER ONE .........................................................................................................................................1

1.1 Background ...........................................................................................................................................1

1.2 ProblemStatement.................................................................................................................................2

1.3 StudyObjectives.....................................................................................................................................3

1.3.1 BroadObjective ..................................................................................................................................3

1.3.2 SpecificObjectives ..............................................................................................................................3

1.4 Research Questions...............................................................................................................................3

1.5 Study Justification ................................................................................................................................4

CHAPTER TWO ........................................................................................................................................5

2.0 Literature Review .................................................................................................................................5

2.1 Introduction/ Definition........................................................................................................................5

2.2 Burden/ Epidemiology ..........................................................................................................................5

2.3 Risk factors for Postpartum Haemorrhage ........................................................................................6

2.4 Causes of Postpartum Hemorrhage ....................................................................................................8

2.4.1 Tone.....................................................................................................................................................8

2.4.2 Trauma................................................................................................................................................8

2.4.3 Tissue...................................................................................................................................................9

2.4.4 Thrombin............................................................................................................................................9

2.5 Active management of the third stage of labor (AMTSL).................................................................9

CHAPTER THREE..................................................................................................................................12

3.0 Research Methodology .......................................................................................................................12

3.1 Study Design........................................................................................................................................12

3.2 Study Area ...........................................................................................................................................12

iii

3.3 Study Population.................................................................................................................................12

3.4 Sample Size Determination ................................................................................................................12

3.5Data Collection Method.......................................................................................................................13

3.7Inclusion Criteria .................................................................................................................................13

3.8 Exclusion Criteria ...............................................................................................................................13

3.9 Ethical Considerations........................................................................................................................13

3.10 Study Limitations..............................................................................................................................13

CHAPTER FOUR.....................................................................................................................................14

4.0 DATA PRESENTATION AND ANALYSIS....................................................................................14

4.1 MOST COMMON TYPE OF PPH ...................................................................................................14

4.2 CAUSES OF PPH ...............................................................................................................................15

4.3 MANAGEMENT OF PPH.................................................................................................................16

CHAPTER FIVE ......................................................................................................................................18

5.0 DISCUSSION OF FINDINGS ...........................................................................................................18

5.1 The Most Common Type of Postpartum Hemorrhage....................................................................18

5.2 The Causes of Postpartum Hemorrhage...........................................................................................18

5.3 Management of Postpartum Hemorrhage ........................................................................................19

CHAPTER SIX .........................................................................................................................................20

6.0 CONCLUSION AND RECOMMENDATIONS ..............................................................................20

6.1 Conclusion ...........................................................................................................................................20

6.2 Recommendations...............................................................................................................................20

REFERENCES..........................................................................................................................................21

APPENDIX ONE ......................................................................................................................................23

APPENDIX TWO .....................................................................................................................................24

APPENDIX THREE.................................................................................................................................25