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.