Bleeding to death after childbirth is devastating
It was on radio a while back that a man contemplating legal suit lamented bitterly about what he claimed as neglect of hospital staff, which led to his wife bleeding to death shortly after she delivered. His wife’s incident is one devastating maternal death in many.
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And so the affirmation of the President and the regrettable story of the widower moved me with concern last week when the Mamaye Campaign on Maternal and Newborn Health launched a Glossary of Terms and Maternal and Newborn Health Facts Sheet in Accra.
At the media launch by Mamaye, the stark reality of some of the needless causes of maternal mortality was not lost on me. It was revealed that haemorrhage after delivery or post-partum haemorrhage (PPH) is the largest direct cause of maternal deaths. Currently in Ghana, 24 per cent of maternal deaths are attributed to this single cause.
PPH is ahead of four other most common direct causes of maternal deaths, which include complications of abortion (11 per cent), hypertensive disorders (nine per cent, sepsis (seven per cent), obstructed labour (four per cent), and miscarriage (four percent). Indirect causes such as malaria, anaemia and other classified infectious and non-infectious cases account for 41 per cent of maternal deaths.
All deliveries come with some level of bleeding. So at what point do we raise an alarm on the level of bleeding after a woman is delivered?
In a chat with Dr Kodwo Koram, a UK-based obstetrician gynaecologist and Fellow of the UK Royal College of Obstetricians and Gynaecologists, with sub-specialty in high risk pregnancy and intra partum care, he explained that primary PPH occurs when 500 millilitres (equivalent of a full Fanta bottle) or more of blood loss occurs within 24 hours of normal delivery. It is at this point that immediate treatment measures should start. A major PPH is when more than 1,000 millilitres of blood is lost and it gets massive as blood loss reaches 2,500 millilitres.
Elaborating on the issue, Dr Koram explained that the average blood volume of any normal person is 5,000 millilitres or five litres. In pregnancy, this is increased by 40 per cent. So anything short of this volume calls for immediate action.
Dr Koram’s explanation was corroborated by Professor Richard Adanu, Dean, School of Public Health, University of Ghana and Country Director, Evidence for Action, Maternal and Newborn Health (Mamaye).
Explaining the case of PPH at the Mamaye media launch last Friday, Professor Adanu called for a serious approach to voluntary blood donation in this country. He explained that much as the medical professionals would do their best in the event of PPH to save lives, the availability of the right blood group for blood transfusion was very critical.
Both Professor Adanu and Dr Koram are unanimous about the attributed causes of PPH which is classified in four main categories, including the inability of the uterus to contract after delivery—which may lead to continuous bleeding. According to Professor Adanu, the uterus should normally contract within seven minutes after delivery.
The other cause of PPH, according to Dr Koram, is the placenta lodging in an abnormal place and causing bleeding into the womb.
He attributed the third cause to trauma from the delivery, which may tear the cervix or the vagina.
The fourth cause is due to a bleeding disorder where there is a failure of clotting in the individual’s system.
Mamaye Campaign tilts more towards improving maternal and newborn health through evidence-based action where problems and challenges in maternal and newborn deaths are brought to the fore for preventive measures and treatments to be identified and implemented.
As Ghana prods on to achieve the Millennium Challenge Goal 5, which is to reduce by three quarters between 1990 and 2015, the maternal mortality ratio and by 2015 bring maternal mortality to 145 deaths per 100,000 live births, what are the needed education and advice we are passing on to expectant mothers and their families as we target needless PPH cases in maternal deaths?
Dr Koram’s advice is that expectant women should take ante-natal clinics very seriously. He suggested that women should ask questions and get educated by experts at the clinics. For his part, Professor Adanu advised that there should be continuous education on women having their babies at health facilities where there are always trained medical personnel or birth attendants. He stressed voluntary blood donation exercises by organisations and individuals to help equip blood banks across the country for such eventualities as PPH. He made a special appeal to the media to contribute to the awareness creation by continuously using their platforms to educate and inform.