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. 2022 Jun;158 Suppl 1(Suppl 1):23-30.
doi: 10.1002/ijgo.14198.

Differences in obstetric practices and outcomes of postpartum hemorrhage across Nigerian health facilities

Aminu Ado Wakili  1 , Ashraf Aswat  2 , Rebecca Timms  2 , Leanne Beeson  2 , Kristie-Marie Mammoliti  2 , Adam Devall  2 , Baba Maiyaki Musa  1   3 , Taiwo Amole  1   4 , Faisal Dankishiya  1 , Arri Coomarasamy  2 , Ioannis D Gallos  2 , Hadiza S Galadanci  1   5
Affiliations

Differences in obstetric practices and outcomes of postpartum hemorrhage across Nigerian health facilities

Aminu Ado Wakili et al. Int J Gynaecol Obstet. 2022 Jun.

Abstract

Objective: To explore differences in obstetric practices and clinical outcomes of postpartum hemorrhage (PPH) in Nigerian facilities.

Methods: A descriptive cross-sectional study of public health facilities providing maternal healthcare services in Nigeria. Surveys were conducted across 38 purposively sampled facilities (January 2020-March 2021) to collect information on obstetric practices related to the management of the third stage of labor, treatment of postpartum hemorrhage, and clinical outcomes related to postpartum hemorrhage in the preceding 12 months.

Results: The median number of annual births per facility was 2230 (IQR, 1952-3283). The cesarean section rate was 21.6% (range 2.1%-52.6%). There was large variability in PPH rate (median 3%, range 0.4%-16.8%) and blood transfusions for PPH (median 2.8%, range 0.4%-48.6%) after vaginal birth. There was less variability for laparotomies (median 0.25%, range 0%-2.8%) and maternal deaths (median 0.11%, range 0%-0.64%) due to PPH after vaginal birth. The number of maternal deaths from all causes varied (median 0.27%, range 0%-3.5%). The rates of PPH and adverse maternal outcomes did not vary substantially between state or federal facilities, region, type of facility, and the number of clinical staff.

Conclusion: Across the Nigerian facilities surveyed there was large variation in PPH rates and adverse maternal outcomes due to PPH. This variability remains largely unexplained and requires further insights and detailed data to gain a deeper understanding of the root causes and challenges to implement customized solutions to improve maternal outcomes.

Keywords: Nigeria; bleeding after pregnancy; clinical practice; maternal death; obstetric hemorrhage; postpartum hemorrhage; pregnancy outcomes.

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Conflict of interest statement

K‐MM, AA, RT, LB, AD, AC, and ID report BMGF funding for the E‐MOTIVE trial paid to the University of Birmingham. Other authors have no conflicts of interest to declare.

Figures

FIGURE 1
FIGURE 1
Map of the hospitals surveyed in Nigeria with the number of births, postpartum hemorrhage rate, and severe maternal outcomes (laparotomy or maternal death from postpartum hemorrhage) displayed
FIGURE 2
FIGURE 2
Proportions of postpartum hemorrhage (PPH) per vaginal birth displayed by state in Nigeria
FIGURE 3
FIGURE 3
Proportions of blood transfusion per birth displayed by state in Nigeria
FIGURE 4
FIGURE 4
Proportions of laparotomy per case of PPH displayed by state in Nigeria
FIGURE 5
FIGURE 5
Proportions of maternal death per case of postpartum hemorrhage (PPH) displayed by state in Nigeria
FIGURE 6
FIGURE 6
Pooled rates and confidence intervals of postpartum hemorrhage (PPH) and severe maternal outcomes across the hospitals surveyed in Nigeria stratified by hospital characteristics
See this image and copyright information in PMC

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