Postpartum Hemorrhage: Why Mothers Die Despite Preventable Treatment

The preventable loss of life during and after childbirth remains a stark reality for many women in low- and middle-income countries. A critical, yet often overlooked, contributor to this tragedy is postpartum hemorrhage (PPH) – severe blood loss following delivery. Professor Hadiza Shehu Galadanci, a leading obstetrician and researcher in Nigeria, has dedicated her career to addressing this challenge, highlighting a frustrating paradox: we possess the knowledge and tools to prevent and treat PPH, yet tens of thousands of women still die annually.

Galadanci, Professor of Obstetrics and Gynaecology at the Aminu Kano Teaching Hospital and founding Director of the Africa Center of Excellence for Population Health and Policy at Bayero University Kano, Nigeria, describes the situation as deeply troubling. “Out of about 14 million women worldwide who will have PPH yearly, the vast majority of the 70,000 who die are dying in low-income and middle-income countries,” she explains. This disparity underscores the critical need for targeted interventions and improved access to care in resource-limited settings.

Understanding Postpartum Hemorrhage

Postpartum hemorrhage is defined as the loss of 500ml or more of blood after vaginal birth or 1000ml or more after a Cesarean section. While some blood loss is expected after childbirth, excessive bleeding can quickly lead to shock, organ failure, and death. The most common cause of PPH is uterine atony – when the uterus fails to contract adequately after delivery, leading to continued bleeding from the site where the placenta was attached. Other causes include retained placental fragments, tears in the birth canal, and blood clotting disorders.

Effective prevention and treatment strategies for PPH are well-established. These include administering medications like oxytocin to help the uterus contract, removing any retained placental tissue, and, in severe cases, performing a uterine massage or even surgical intervention. However, the availability of these interventions, along with trained healthcare providers and adequate blood supplies, is often limited in the regions where PPH is most prevalent.

A Nigerian Perspective: Challenges and Progress

Nigeria faces a particularly high burden of maternal mortality, with PPH being a leading cause. According to Hadiza Galadanci’s profile, approximately 75,000 women in Nigeria die each year during pregnancy or delivery, with around a quarter of these deaths attributed to PPH. This figure, while alarming, also highlights the potential for significant impact through focused interventions.

Galadanci’s perform at the Aminu Kano Teaching Hospital and the Africa Center of Excellence for Population Health and Policy is centered on improving obstetric outcomes and strengthening maternal health systems. Her research focuses on identifying effective strategies for preventing and managing PPH, as well as training healthcare workers in lifesaving interventions. She is known for her work on the E-MOTIVE study, which aims to improve the management of PPH through a package of interventions including training, equipment provision, and mentorship.

The Role of the Africa Center of Excellence

The Africa Center of Excellence for Population Health and Policy, directed by Galadanci, is a World Bank-supported initiative dedicated to advancing healthcare research and policy in Africa. The center plays a crucial role in building capacity for research, training healthcare professionals, and disseminating evidence-based practices to improve population health outcomes. Her research profile on ResearchGate shows she has been cited 4268 times, demonstrating the impact of her work.

The center’s approach is multifaceted, encompassing not only clinical interventions but also policy advocacy and community engagement. By working with governments, healthcare providers, and communities, the center aims to create a sustainable impact on maternal health outcomes across the continent.

Beyond Intervention: Addressing Systemic Barriers

While clinical interventions are essential, addressing the systemic barriers that contribute to PPH and maternal mortality is equally important. These barriers include limited access to healthcare, particularly in rural areas; inadequate infrastructure; lack of skilled birth attendants; and cultural factors that may delay women from seeking care.

Galadanci’s work recognizes the importance of addressing these broader issues. She advocates for strengthening healthcare systems, improving access to essential medicines and supplies, and empowering women to make informed decisions about their health. Her experience, as highlighted in the Gates Foundation article, underscores the need for practical innovations and local leadership in saving mothers’ lives.

What Comes Next: Strengthening Surveillance and Expanding Research

Continued efforts are needed to strengthen surveillance systems for PPH and maternal mortality, allowing for more accurate tracking of trends and identification of areas where interventions are most needed. Further research is also crucial to identify new and innovative strategies for preventing and managing PPH, particularly in resource-limited settings. This includes exploring the potential of new technologies, such as point-of-care diagnostics and mobile health interventions, to improve access to care and enhance the quality of services.

The work of Professor Hadiza Shehu Galadanci serves as a powerful reminder that maternal mortality is not inevitable. By combining clinical expertise, research innovation, and a commitment to addressing systemic barriers, we can make significant progress towards ensuring that every woman has a safe and healthy childbirth experience.