A description of guideline utilization in managing third trimester antepartum hemorrage at Garissa provincial general hospital
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.