Postpartum Hemorrhage Prevention: A Case Study in Northern Rural Honduras

Authors

  • Lisa Kane Low CNM, PhD,

    Corresponding author
      University of Michigan, 400 North Ingalls Rm 3249, Ann Arbor, MI 48103. E-mail: kanelow@umich.edu
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    • Lisa Kane Low, CNM, PhD, FACNM, is an Assistant Professor in the School of Nursing and College of Literature Science and the Arts, Program in Women's Studies at the University of Michigan.

  • Joanne Motiño Bailey CNM, FNP, PhD,

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    • Joanne Motiño Bailey, CNM, FNP, PhD, is a Lecturer, College of Literature, Science and the Arts, Program in Women's Studies at the University of Michigan and director of the University of Michigan Nurse Midwifery Service.

  • Emma Sacks BA,

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    • Emma Sacks, BA, is a doctoral student at Johns Hopkins School of Public Health focusing on international maternal child health.

  • Lilian Medina RN,

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    • Lilian Medina, RN, is a licensed professional nurse and director of nursing for the Clínica Materno-Infantil, Ministerio de Salud Pública in Morazán, Yoro, Honduras.

  • Hector Oqueli Lopez Piñeda MD

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    • Hector Oqueli Lopez Piñeda, MD, is the Medical Director for Ministerio de Salud Pública, Department of Yoro, Honduras.


University of Michigan, 400 North Ingalls Rm 3249, Ann Arbor, MI 48103. E-mail: kanelow@umich.edu

Abstract

Postpartum hemorrhage (PPH) is the leading cause of maternal mortality globally. Safe Motherhood policies have been directed towards the reduction of PPH by recommending active management of third-stage labor as the standard of care. One component of active management involves routine use of a uterotonic agent within 1 minute of the delivery of the baby. A case study at Clínica Materno-Infantil, a free-standing public birth center in Honduras, is presented, focusing on methods to reduce PPH. The nursing staff was trained to estimate blood loss and in methods to manage PPH, including elements of active management of the third stage of labor. Medical records were reviewed and an analysis of PPH management compared to estimated blood loss (EBL) was conducted. There was no significant correlation between PPH management techniques and EBL (r = .368). There was a statistically significant (P < .001) correlation between oxytocin administration and lower EBL (r = –.232), indicating that there was less blood loss when oxytocin was administered. At Clínica Materno-Infantil, routine use of a uterotonic agent appears beneficial and further implementation of active management of the third stage of labor appears warranted.

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