Assessment of quality of care in the management of postpartum haemorrhage: A review of selected maternal death cases

Abstract

Obstetric haemorrhage was the third most common cause of maternal death in South Africa for the triennium 2008 to 2010, increasing from the rate in 2005 to 2007. The major causes of death from haemorrhage remained similar during 2005 to 2010. Provincial assessments assert that 80.1% of these deaths were avoidable. Patient-related avoidable factors, mostly delay in seeking care, were present for only a third of the total deaths. A worrying 30.7% of deaths were due to lack of appropriately trained doctors or nurses. At least at the primary care level, midwives are expected to be able to recognise, manage and refer cases of postpartum haemorrhage (PPH). National management protocols inform practice in this area, since professional regulations are lacking. The primary objective of this study was to assess the clinical practices of midwives in managing postpartum haemorrhage and to report on the quality of care during this process. A quantitative design was utilised in this exploratory, descriptive study. The results of the analysis showed that the general quality of care was poor and basic lifesaving measures were only performed in half of the cases. In view of the maternal deaths caused by postpartum haemorrhage, poor quality of care by midwives should be urgently addressed.