Postpartum haemorrhage PPH is considered the main cause of deaths related to

Postpartum haemorrhage (PPH) is considered the main cause of deaths related to pregnancy worldwide (Say et al., 2014; Alkema et al., 2016; Ngwenya, 2016).More than 90% of native deaths occur in poor countries, while 30% of these deaths are attributed to excessive blood loss commonly known as PPH (McDonald, 2007). However, obstetrical hemorrhage continues to be a major cause of maternal mortality even in developed countries.About 140,000 women die each year from this complication (Abou Zahr, 2003), which translates to 1 death every 4 minutes. Although PPH deaths in Western countries have dropped drastically in recent years, it remains one of the major causes of pregnancy-related deaths in the United States, France and the UK (Bouvier-Colle et al., 2001; Hall M (2004).). In addition to death, PPH is also an important cause of morbidity associated with pregnancy. Unfortunately, although there are several risk factors, PPH often occurs without warning.Approximately 90% of native deaths in 2011 were equally distributed between Asia and Sub-Saharan Africa (WHO, 2010), but the dangers are higher in Africa because it has a smaller population than Asia. For decades, Sub-Saharan Africa has been the region with the world’s highest maternal mortality rate in over 500 deaths per 100,000 live births. In this region, the number of births attended by qualified health personnel and expected life expectancy at birth are strongly linked to maternal mortality. For example, increasing the ability to measure maternal mortality in Afghanistan revealed a suspect but unconfirmed reality. The retrospective cohort study conducted by the Center for Disease Control and Prevention (CDC) among women of reproductive age in four selected districts in four Afghan provinces reported an impressive mortality rate of 1900 deaths per 100,000 live births (Bartlett et al ., 2005). However, a subsequent study in seven districts of Herat province in Afghanistan reported that this level was 593 deaths per 100,000 live births per year (Amowitz et al., 2002), again being a much higher level compared to developed. The reasons for this extremely high maternal mortality rate include non-respect of human rights, lack of access and low quality of health services; food, inadequate housing and lack of safe water; as well as the denial of individual rights such as free marriage, access to birth control methods, birth rates, and space between births (Amowitz et al., 2002).About 60% of all maternal deaths occurring during pregnancy occur during the postpartum period and one source suggests that about 45% of them occur in the first 24 hours after birth (Li et al., 1996).Compared to the four major causes of direct deaths of mothers – hypertensive disease, obstructed or prolonged birth, unsafe abortions and severe infections:- PPH causes death very soon. Also in most cases is sudden and immediate. This means that in an environment where the presence of trained staff in the east is on the rise and many births are occurring in health centers, other causes can be handled efficiently, while PPH will soon turn into a prevalent cause of death of the mother. Deaths from other causes are easier to prevent through an effective referral system. In the countries with the lowest available resources, PPH needs additional attention to reduce the maternal mortality rate. In this light, the introduction of appropriate measures for PPH management at the non-hospital level should be seen.The risk of death from PPH depends not only on the amount and extent of the loss of blood but also on the woman’s health condition (Coombs, 1991). Poverty, lifestyle, malnutrition and lack of women’s decision-making power to control their reproductive health are some of the major issues that unfortunately have been accepted as inevitable and unchanged. Still today in many parts of the world midwives, nurses and other trained health workers can not use medicines at their will to prevent and / or treat PPHs. The covert reality of touching a PPH is that two-thirds of women who experience it have no identifiable clinical risk factors such as multiple births or fibroids. In this regard, PPH has an equal probability of being encountered in women of different socio-economic levels. However, PPH is not an equal killer because poor, malnourished and diseased women who are born without proper health care often die from it, while the luckiest women who may be born in medical facilities

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