Factors affecting the prevention of postpartum hemorrhage in Low- and Middle-Income Countries: A scoping review of the literature

Abstract

Background and objectives: Postpartum hemorrhage is an important cause of maternal mortality worldwide. A host of literature highlights the difficulty in predicting which women will experience Postpartum hemorrhage. The present study aims at describing the research output on factors affecting the prevention of Postpartum hemorrhage in Low- and Middle- Income Countries.Methods: A total of 24 published research articles and 2 papers from grey literature published between 2010 and 2019 were retrieved from PubMed, Scopus, CINAHL and Nursing and Allied Health Database (ProQuest). Data were extracted based on main study features and the findings were described narratively. Arksey and O’Malley’s framework for scoping studies was used in this review.Results: Findings from the literature from Low- and Middle- Income Countries are grouped into three themes: Knowledge and understanding about the prevention of Postpartum hemorrhage; Postpartum hemorrhage risk factors among childbearing women; and use of prophylactic uterotonic drugs for PPH prevention and related policies. The majority of studies investigate pharmacological interventions for PPH prevention, while few address the early assessment of risk factors associated with Postpartum hemorrhage for proactive prevention.Conclusions: The present study suggests that assessing risk factors associated with PPH would be a practical method for early identification of clients at high-risk for developing Postpartum hemorrhage. The present scoping review highlights the paucity of research considering Postpartum hemorrhage risk factors in low- and middle- income countries, particularly in Rwanda. Further qualitative research on the perceptions of health care workers and beneficiaries about Postpartum hemorrhage risk factors is warranted, to enable the development of a tool to assess risk factors associated to Postpartum hemorrhage among childbearing women in Low- and Middle- Income Countries.

Who is at risk? The development of a tool to predict and prevent postpartum hemorrhage

“…After consultation of the literature on PPH risk factors, the conclusion from the second round was to keep all items from the first round as the team was of the view that all items could be PPH risk factors from antenatal, intrapartum and postpartum periods. The RATP was then shaped with 46 items in three content domains (sections) on the tool: Section A, Social demographic characteristics of the woman (Items 1-10); Section B, Newborn and mother anthropometry and hemoglobin measurements (Items [11][12][13][14]; Section C, Pregnancy, obstetric, intrapartum and immediate postpartum factors (Items 15-46). The items are listed in Table 3.…”

“…In this study, we developed a content validated risk assessment tool for the prediction and prevention of PPH among childbearing women (RATP). To design the RATP, the items were generated from previous phases of this study which are published elsewhere: a scoping review [12] to describe the research output on factors affecting the prevention of PPH in low and middle income countries and a qualitative descriptive study [13] to explore the influencing factors for early detection and prevention of PPH as perceived by beneficiaries and health workers in the Northern Province of Rwanda. Our process to generate items is in agreement with Zamanzadeh et al [28] in a study focusing on the process used to assess content validity.…”

“…The content domain or construct is identified by literature review, content analysis, and/or by conducting interviews with the respondents or focused groups. [31] For the present study, a scoping review and qualitative descriptive study [12,13] were conducted to determine the content domain. This first step helped the researcher to identify an agreed definition of the domain of study and generate items at a preliminary stage.…”

“…[32] At this step Boateng et al [30] suggest that the researcher confirm that there are no existing instruments that will adequately serve the same purpose. To this end, we conducted a scoping review [12] which confirmed that no such tool has been developed for use in low-and middle-income countries. Step 2 was to generate items which is also called question development.…”

“…Numerous factors contributing to high PPH morbidity and mortality rates have been identified both in developed and developing countries. In our previous two studies, [12,13] we conducted a scoping review and a qualitative descriptive study to identify salient factors associated with PPH, which concluded that it is important to set up strategies and approaches for early recognition of women at higher risk of developing PPH. Prata, Bell and Weidert [14] argue that structural barriers are further complicated by difficulties in predicting who will develop PPH.…”