Abstract: One of the millennium development goals set by the United Nations is to reduce maternal mortality by three quarters by 2015. The achievement of this goal must focus on understanding the dynamics of the causes of maternal mortality and removing such causes. Postpartum haemorrhage ranks high among the causes of maternal mortality, especially in Nigeria. This study was designed to determine the prevalence, management and outcome of postpartum haemorrhage in selected health care settings. This study was a retrospective analysis of cases of postpartum haemorrhage (PPH) in selected health care facilities from primary, secondary and tertiary health care levels in Ile-Ife, Nigeria between January, 2004 and December, 2008. The prevalence of PPH during the study period was 1.6, 3.9 and 3.4% in the tertiary, secondary and primary health care institutions respectively. Chi square showed a significant association between booking status and occurrence of PPH (c2 = 18.51, df = 1, P = 0.001), parity and PPH (c2 = 21.49, df = 3, P = 0.000), and mode of delivery and PPH (c2 = 111.77, df = 2, P = 000). Retained placenta and retained placental bits of tissue were major causes of PPH (52.4%). Major risk factors identified were multiple gestation (20%), antepartum haemorrhage (15%) and previous PPH (12.5%). Uterotonic (ergometrine and/or syntocinon) was widely used (100%) as first line of management with misoprostol being rarely used (7.3%). This study showed that prior booking of pregnant women for antenatal care was associated with lower prevalence of PPH as higher prevalence was recorded among unbooked clients. Therefore, midwives and other health care providers most especially at the rural area must ensure that women are mobilised and encouraged to register for antenatal care as early as possible for appropriate maternity care, early identification of risk and preparation to reduce the untoward effect.
Key words: Maternal mortality, labour, primary postpartum haemorrhage, uterotonic, retrospective study.