TABLE OF CONTENTS
Content Page
Title page
i
Certification
ii
Dedication iii
Acknowledgements
iv
Abstract
v
Table of Contents
vi
List of Tables xi
List of Figures x
Appendices xi
Abbreviations xii
CHAPTER ONE: INTRODUCTION
1.1 Background to the Study 1
1.2 Statement of the Problem 3
1.3 Significance of the Study 4
1.4 Scope of the Study 4
1.5 Objective of the Study 4
1.6 Research Questions 5
1.7 Hypotheses 5
1.8 Operational Definition of Terms 6
CHAPTER
TWO: REVIEW OF LITERATURE
2.0 Introduction 7
2.1 Concept of Postpartum Haemorrhage 7
2.2 Relationship between Postpartum Haemorrhage
and Maternal Mortality 7
2.3 Classification of Postpartum Haemorrhage 8
2.3.1
Blood loss Quantification 8
2.3.1.1 Blood loss during and after Delivery 8
2.3.1.2 Hematocrit Changes 9
2.3.1.3
Blood Loss Rate 9
2.3.1.4 Blood volume insufficiency 9
2.4 Etiology of Postpartum Haemorrhage 10
2.4.1 Atonic uterus 10
2.5 Pathophysiology of Postpartum Haemorrhage 12
2.6 Evidence based Measures for immediate
Management of Postpartum
Haemorrhage
12
2.7 Non-Pneumatic Anti-shock Garment, strategy
against Postpartum
Haemorrhage 13
2.8 History of Non-Pneumatic Anti-shock Garment 13
2.9 Mechanism of action of NASG 14
2.10 Application of NASG 14
2.10.1
Procedure of Application 14
2.10.2 Procedure for NASG Removal15
2.10.3 Contra-indications to NASG 15
2.11 Benefits of the NASG 15
2.12 Empirical Studies 16
2.13 Evidence based report of NASG for Postpartum Haemorrhage in
University College Hospital, Ibadan, Nigeria 17
2.14 Misoprostol 18
2.15 Concept of Active Management of third Stage of
Labour 19
2.16 Trends of Uterotonic drugs used in the Prevention of PPH 19
2.17 Reasons why Misoprostol is Preferred 20
2.18 Misoprostol and its Mode of Action 20
2.19 Benefits of Misoprostol over other conventional Uterotonic drugs in management of postpartum haemorrhage 21
2.20 Empirical Studies on Misoprostol 21
2.21 Expanding Midwives Skills 22
2.22 Theoretical Model 23
2.22.1
Bloom’s Model 23
2.22.2The Cognitive Domain 24
2.22.3 The Psychomotor Domain
25
2.23 Application of Model to the Study 25
2.24 Application of the Psychomotor Domain in the Application
of NASG 26
2.25 Conceptual Model; source; adapted from bloom
taxonomy (1956)27
CHAPTER THREE: METHODOLOGY
3.0 Introduction
28
3.1 Research Design 28
3.2 Population 28
3.3 Sample size and sampling Technique 29
3.4 Instrument 30
3.5 Validity and Reliability of Instrument 30
3.6 Method of Data Collection 30
3.7 Method of Data Analysis 31
3.8 Ethical Consideration 32
CHAPTER FOUR: DATA ANALYSIS, RESULTS
AND
DISCUSSIONOF FINDINGS
4.0 Introduction 33
4.1 Data Analysis and Result Presentation 33
4.2 Discussion of Findings 43
CHAPTER FIVE: SUMMARY, CONCLUSION AND
RECOMMENDATIONS
5.1 Summary 52
5.2 Conclusion 53
5.3 Recommendations 54
5.4 Limitation of the study 54
5.5 Suggestion for Further Studies 54
REFERENCES 56
APPENDICES 62
LIST OF
TABLES
Table Page
2.1 Showing Standardized Classification of PPH as
described by Benedetti 10
4.1 Showing Frequency and Percentage on participant’s
Socio Demographic data 33
4.2 Showing Pre and Post Intervention Knowledge
level of Midwives on
Misoprostol
usein the Management of PPH in Control and Experimental
groups 35
4.3 ShowingPre and post Intervention Knowledge level of
Midwives in the use of NASG in the Management of PPH in the
Control and Experimental Groups 36
4.4Showing Application of NASG by the Midwives in the Management of PPH Pre and Post Intervention in the Control and Experimental group. 37
4.5ShowingRemoval of NASG by the Midwives in the Management of PPH
Pre and post intervention in the Control
and Experimental group. 38
4.6Showing Inferential Statistics comparing mean scores of Post Intervention BKnowledge of Misoprostol and NASG in the Control and Experimental group 40
4.7Showing Inferential Statistics comparing mean scores of Post Intervention Knowledge of Misoprostol and NASG in the Control and Experimental group 41
4.8Showing Inferential Statistics comparingKnowledge mean scores of Misoprostol use in Experimental group Pre and Post intervention 42
4.9Showing Inferential Statistics comparingPre and Post Skills in the Application of NASG 43
LIST OF FIGURES
Figure Page
1 Conceptual Model 27
2. Research Design 28
APPENDICES
Appendix Page
Informed Consent Form 62
Questionnaire 63
Pathfinder Teaching Package 68
Pictures from the field work 73
ABBREVIATIONS
PPH Postpartum Haemorrhage
NASG Non
Pneumatic Antishock Garment
BUHREC Health Research Ethics Committee
OSHREC Ondo State Health Research Ethics Committee
SPB Systolic
Blood Pressure
UNFPA The
United Nationsfund for population activities
POPPHI Prevention of postpartum haemorrhage initiative
AMTSL Active
Management of Third Stage of Labour
CCT Control
Cord Traction
ANC Antenatal
Clinic
CHWs
Community
Health Workers
FMOH &nbs