| dc.description.abstract | currently accounts for 34% maternal deaths in Africa (Khan KS et al Lancet 2006).
Objective: To describe gaps in Kenya National guidelines utilization in managing ante
partum hemorrhage in 3rd trimester and compare pregnancy outcomes in cases managed
according to the guidelines and those where guidelines were not followed.
Methodology: Mixed methods study with cross sectional survey of adherence to guidelines
among patients managed for APH and qualitative Key Informant Interviews (KIIs) of Halth
workers. Data on guideline adherence were collected through an audit of medical records of
patients admitted with APH while health worker perspectives on APH guidelines were
obtained through KIIs. Guideline adherence was determined as composite of identification of
features and causes of 3rd trimester APH, appropriate pelvic examination and proper
monitoring and management of ruptured uterus. Association between guideline adherence
and independent variables were determined using chi-square tests.
Results: Sixty (98.4%) patients had at least one of the guideline identified presenting
complaints. Placenta praevia in 27.9% and placenta abruption 26.2%. Speculum examination
was done in 78.7% whereas signs of ruptured uterus were identified in 18% of whom 54.5%
had both laparatomy and blood samples taken. Delivery plans were documented for 55
patients with regular feto-maternal monitoring done in 52.5% while 50.8% had favourable
outcomes. Based on above results, 36.1% of the cases were assessed to have been managed
with good adherence to guidelines . Responses from 19 KIIs established high levels of
awareness of the existence of guidelines, with utilization challenges attributed to resource
inadequacies.
Conclusion and Recommendation: Clinicians are aware and trained on APH guidelines, but
adherence practices are still low. Therefore, continuous appraisal of clinical practices,
availing equipment, facilities and supplies to reinforce adherence is recommended. | en_US |
