Towards 2015: post-partum haemorrhage in sub-Saharan Africa still on the rise.

AIMS AND OBJECTIVES: To review literature from 1996-2012 relating to factors associating with the persistent maternal mortality rate (MMR) caused by post-partum haemorrhage (PPH) in sub-Saharan Africa.

BACKGROUND: One woman dies every seven minutes, at the same time, one-quarter of all maternal death worldwide is being caused by PPH. The aim of United Nations Fifth Millennium Development Goal 5 is to lower MMR by three quarters between 1990-2015.

DESIGN: Narrative literature review.

METHODS: Study articles from 1996-2012 were searched in electronic databases MEDLINE, Cochrane, PubMED, Google's scholar and manual searches. Combinations of the following search words were used: post-partum haemorrhage/bleeding, sub-Saharan Africa/rural areas, antenatal/obstetric care/maternal mortality/skilled care at birth/maternity care/health survey. 125 article abstracts were read, and 50 full articles used in this review.

RESULTS: Every day about 800 women died due to birth complications in 2010: of the 800 maternal deaths worldwide, 440 occurred in sub-Saharan Africa with PPH being the main cause. Common causes of PPH are related to failure of the healthcare system, inaccurate estimation of blood loss after delivery and lack of skills to prevent and manage PPH.

DISCUSSION: Special attention is needed with emphasis on regular attendance of antenatal clinic, proper information concerning pregnancy and delivery, skills to accurate estimate blood loss, and prevention and management of PPH.

CONCLUSION: PPH is the leading cause of MMR in areas where essential care and skilled health attendants are limited. Basic Emergency Obstetric Care and arrangements for timely referral to the big hospital with facilities must be practiced everywhere.

RELEVANCE TO CLINICAL PRACTICE: This review may help to remind health workers and the government that maternal mortality due to PPH is still higher and more interventions are needed.