An Evaluation of Nurses’ Adherence to Postpartum Hemorrhage Management Protocols at Federal Teaching Hospital, Gombe
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Background of the Study
Postpartum hemorrhage (PPH) remains one of the leading causes of maternal mortality worldwide, particularly in low- and middle-income countries, including Nigeria (World Health Organization [WHO], 2024). Defined as excessive bleeding exceeding 500 mL after vaginal delivery or 1000 mL after cesarean section, PPH is a major obstetric emergency requiring prompt and effective intervention (Okafor et al., 2024). Despite global efforts to improve maternal health outcomes, the high burden of PPH-related deaths in Nigeria underscores gaps in emergency obstetric care, including nurses’ adherence to established management protocols (Aliyu & Salisu, 2023).
Federal Teaching Hospital, Gombe, serves as a referral center for obstetric emergencies, including PPH cases. Nurses play a critical role in PPH management by administering uterotonic drugs, monitoring blood loss, ensuring timely referrals, and adhering to life-saving protocols such as the active management of the third stage of labor (AMTSL) (Bello et al., 2024). However, studies suggest that inconsistent adherence to these guidelines, lack of training, and inadequate resources contribute to preventable maternal deaths (Eze & Okonkwo, 2023).
While several studies have examined PPH prevalence and risk factors, there is limited empirical data on nurses' adherence to PPH management protocols in Nigerian healthcare settings. Understanding the extent to which nurses comply with recommended guidelines is essential for improving maternal health outcomes (Adebayo et al., 2024). This study seeks to evaluate nurses’ adherence to PPH management protocols at Federal Teaching Hospital, Gombe, identifying factors influencing compliance and potential areas for improvement.
Statement of the Problem
PPH remains a critical public health issue, accounting for a significant proportion of maternal deaths in Nigeria (WHO, 2024). Despite the availability of evidence-based protocols for PPH management, many healthcare facilities struggle with suboptimal adherence due to inadequate staffing, lack of continuous medical education, and logistical constraints (Okonkwo & Yusuf, 2023). Federal Teaching Hospital, Gombe, is no exception, as reports indicate persistent maternal mortality linked to PPH, raising concerns about the effectiveness of current nursing interventions (Ali et al., 2024).
Although nurses are well-positioned to implement PPH management protocols, barriers such as delayed recognition of excessive bleeding, inconsistent administration of uterotonics, and inadequate emergency preparedness compromise patient outcomes (Eze & Musa, 2024). Given the importance of timely and standardized care in preventing maternal deaths, an evaluation of nurses’ adherence to PPH protocols is essential for strengthening obstetric emergency responses.
Objectives of the Study
- To assess the level of nurses’ adherence to PPH management protocols at Federal Teaching Hospital, Gombe.
- To identify factors influencing nurses' compliance with PPH management guidelines.
- To evaluate the impact of adherence to PPH protocols on maternal health outcomes.
Research Questions
- To what extent do nurses adhere to PPH management protocols at Federal Teaching Hospital, Gombe?
- What factors influence nurses’ compliance with PPH management guidelines?
- How does adherence to PPH protocols impact maternal health outcomes?
Research Hypotheses
- Nurses at Federal Teaching Hospital, Gombe, adhere to PPH management protocols to a significant extent.
- Factors such as training, resource availability, and workload influence nurses’ compliance with PPH management protocols.
- Higher adherence to PPH management protocols is associated with improved maternal health outcomes.
Scope and Limitations of the Study
This study will focus on nurses working in the obstetric unit at Federal Teaching Hospital, Gombe. Limitations may include variations in clinical practice, potential recall bias in self-reported adherence, and constraints in accessing complete hospital records.
Definitions of Terms
- Postpartum Hemorrhage (PPH): Excessive bleeding following childbirth, classified as primary (within 24 hours) or secondary (after 24 hours).
- Adherence: The extent to which nurses follow established PPH management guidelines.
- Active Management of the Third Stage of Labor (AMTSL): A recommended set of interventions to prevent PPH, including uterotonic administration, controlled cord traction, and uterine massage.
- Maternal Mortality: Death of a woman due to pregnancy-related complications, including PPH.
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