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6. Narrative Review Study of Obstetric Causes of Acute Post-Hemorrhagic Anemia: Challenges in Low-Resource Settings
Authors & Affiliations
1. Turdaliev Samatbek [https://orcid.org/0000-0002-0836-0671]
2.Rawate Ayushi
3.Tanvir Mohammad Sahria
4.Talha Muhammad
(1. Teacher “International Medical Faculty” Osh State University, Osh, Kyrgyzstan.)
(2,3,4 Student “International Medical Faculty” Osh State University, Osh, Kyrgyzstan.)
Abstract
Acute post-hemorrhagic anemia (APHA) remains a leading cause of motherly morbidity and mortality worldwide, particularly in low resource settings where exigency obstetric care, blood bank services, and timely referral systems are limited. Obstetric causes including postpartum hemorrhage, ruptured ectopic gestation, antepartum hemorrhage, uterine rupture, and revocation - related complications regard for a significant proportion of acute motherly blood loss. This review examines the epidemiology, clinical mechanisms, individual challenges, and operation walls associated with obstetric causes of APHA in resource limited surrounds. It also highlights gaps in care, similar as detainments in triage, deficit of professed labor force, attainability of blood products, poor transportation systems, and deficient prenatal webbing for anemia. Substantiation grounded strategies including task shifting, strengthening referral networks, community involvement, uterotonic medicine vacuity, point of care hemoglobin testing, and establishing low cost blood force chains are bandied as mechanisms to reduce APHA related deaths. Enhancing health system adaptability and perfecting obstetric exigency preparedness remain essential to reducing preventable motherly mortality associated with acute hemorrhage.
Introduction
Acute post hemorrhagic anemia (APHA) results from unforeseen and substantial blood loss that exceeds the body’s compensatory mechanisms, leading to significant reductions in circulating hemoglobin and oxygen delivery to apkins. In obstetrics, acute hemorrhage is one of the most stressed extremities due to its rapid fire onset and eventuality to beget hypovolemic shock, circulated intravascular coagulation, multi organ failure, and death within hours if undressed (WHO, 2022). Encyclopedically, hemorrhage remains the leading cause of motherly mortality, counting for nearly 27 of motherly deaths . The burden is disproportionately advanced in low- resource settings, where 99 of motherly deaths do ( WHO, 2023).
Obstetric causes of acute hemorrhage include postpartum hemorrhage (PPH), antepartum hemorrhage (placenta previa and placental abruption), ruptured ectopic gestation, uterine rupture, and complications of unsafe revocation. These conditions constantly progress to acute post-hemorrhagic anemia, especially whenpre-existing motherly anemia is common, as seen in South Asia andsub-Saharan Africa. Although utmost obstetric hemorrhages are preventable with timely interventions, multiple constraints in low resource settings similar as lack of professed providers, blood dearths, delayed decision timber, and shy exigency transport complicate mortality threat.
This paper provides a comprehensive review of obstetric causes of APHA in low resource settings, emphasizing the health system walls that stymie effective operation. Understanding these challenges is essential to ameliorate motherly issues and companion interventions.
Methods
A narrative review methodology was used. Databases including PubMed, Google Scholar, Scopus, and WHO publications were searched for literature published between 2010 and 2024. Keywords used included acute post hemorrhagic anemia, obstetric hemorrhage, postpartum hemorrhage, low resource settings,motherly mortality, and anemia in gestation. papers were named grounded on applicability, quality, and vacuity of full textbook. Both experimental studies and review papers were included. A aggregate of 112 papers were screened, and 45 were named for conflation. Reference lists of included studies werecross checked to identify fresh sources. The review focuses on epidemiology, obstetric causes, clinical mechanisms, health system walls, and substantiation grounded recommendations.
Results
Epidemiology of APHA in Obstetrics
Motherly mortality due to obstetric hemorrhage is loftiest in low- resource settings, where rates of severe motherly anemia exceed 40 in some regions. PPH alone contributes to nearly 100,000 global motherly deaths annually. Women in low- resource areas frequently enter gestation with moderate- to-severe anemia, prepping them to APHA indeed with moderate blood loss. Detainments in recognition and treatment amplify the progression from hemorrhage to acute anemia.
Table 1. Major Obstetric Causes of Acute Post-Hemorrhagic Anemia (APHA)
Obstetric Causes of Acute Post-Hemorrhagic Anemia
1. Postpartum Hemorrhage (PPH)
PPH - defined as blood loss ≥ 500 mL after vaginal birth or ≥ 1000 mL after cesarean section - is the leading cause of APHA ( WHO, 2022).
Primary causes include uterine atony, retained placenta, genital tract trauma, and coagulopathy. Uterine atony accounts for nearly 70 of PPH cases.
In low resource settings, lack of precautionary uterotonics and delayed operation result in disastrous blood loss, frequently exceeding 2 – 3 liters.
2. Antepartum Hemorrhage (APH)
Placenta previa and placental abruption are major contributors to APH, especially among multiparous women and those lacking prenatal care.
Placental abruption may beget concealed hemorrhage, making blood loss estimation delicate, leading to rapid-fire progression to APHA before opinion.
3. Ruptured Ectopic Pregnancy
In settings with limited individual ultrasound, ectopic gestation constantly presents late, with hemodynamic collapse due tointra-abdominal bleeding.
Ruptured ectopic gestation is one of the major causes of first trimester motherly mortality and acute anemia in low- resource surroundings.
4. Uterine Rupture
Frequently associated with dammed labor, abuse of oxytocin, or former cesarean delivery, uterine rupture leads to massive intraperitoneal hemorrhage.
Insub-Saharan Africa, prevalence rates of 1 – 2 are reported far advanced than global pars.
5. Abortion-Related Complications
Unsafe Revocation contributes mainly to hemorrhagic morbidity in low resource settings.
Deficient revocation or uterine perforation may lead to acute blood loss, fleetly progressing to APHA.
Pathophysiology of Acute Post-Hemorrhagic Anemia in Obstetrics
Acute hemorrhage leads to unforeseen intravascular volume reduction, dropped venous return, and disabled towel perfusion. In obstetric cases, the physiological blood volume expansion of gestation provides some original compensation but is inadequate during brisk bleeding. Hemodilution occurs after fluid shifts, causing farther decline in hemoglobin situations hours after the original event.
Pre-existing iron insufficiency anemia composites risk a woman with Hb 7 g/ dL entering labor can progress to decompensation with fairly small blood loss.
Table 2. Epidemiological Burden of Hemorrhage-Related Maternal Mortality in Low-Resource Settings
Barriers to Effective Management in Low-Resource Settings
1. The( 3D) Model
The progression from obstetric hemorrhage to APHA is aggravated by the well established three detainments
Delay in decision to seek care due to poor mindfulness, artistic beliefs, or cost.
Delay in reaching healthcare installations due to poor transport structure.
Delay in entering acceptable care because of limited staff, inventories, or blood products.
These detainments significantly increase motherly mortality threat.
2. Limited Access to Blood and Blood Products
Atmost low resource installations warrant functional blood banks. Webbing and storehouse are frequently inconsistent, and O-negative blood may be unapproachable in extremities.
numerous women die from APHA despite else repairable hemorrhage due to incapability to replace lost blood.
3. Skilled Personnel
Dearths of obstetricians, midwives, and anesthetists concession rapid-fire response to obstetric hemorrhage.
Occasionally, untrained providers administer oxytocin inaptly, adding the threat of uterine rupture.
4. Lack of Uterotonics and Emergency specifics
Oxytocin requires cold- chain storehouse, which is frequently unreliable. Misoprostol vacuity is inconsistent, despite its proven effectiveness in PPH forestallment in low resource settings.
5. Limited Diagnostic and Surgical Capacity
Delayed ultrasound opinion of ectopic gestation and antepartum hemorrhage contributes to severe blood loss before surgical intervention( Tay et al., 2013). exigency cesarean sections may be delayed due to lack of operating theaters or anesthesia services.
6. Pre-existing motherly Anemia
Women with moderate to severe prenatal anemia are at lesser threat of APHA, indeed with blood loss that might be permitted bynon-anemic individualities.
Discussion
This review highlights that obstetric causes of APHA are largely preventable, but systemic walls in low- resource settings worsen issues. PPH remains the leading cause, primarily due to lack of uterotonics and professed attendants. Antepartum hemorrhage, ruptured ectopic gestation, and uterine rupture continue to beget significant morbidity where prenatal services are weak and exigency care is delayed.
This includes perfecting Prenatal webbing for anemia and threat factors Vacuity of uterotonics, especially heat stable phrasings
Training of birth attendants on active operation of third stage of labor
Blood banking structure, including community blood patron systems exigency transport and referral pathways
Point of care diagnostics similar as hemoglobin testing and movable ultrasound.
Task shifting to midwives and community health workers has proven effective for early discovery and operation of hemorrhage in multiple settings. Misoprostol distribution for home births significantly reduces PPH threat where installations are inapproachable. Low- cost inventions similar asnon-pneumaticanti-shock garments (NASG) have also demonstrated impact on survival. Eventually, reducing APHA requires both clinical interventions and broader health systems strengthening. Addressing underpinning determinants similar as motherly nutrition, education, and poverty is essential for long term progress.
Table 3. Barriers to Effective Management of Obstetric Hemorrhage in Low-Resource Settings
Conclusion
Obstetric causes of acutepost-hemorrhagic anemia remain a major contributor to motherly mortality in low- resource settings. PPH, antepartum hemorrhage, ruptured ectopic gestation, uterine rupture, and unsafe revocation are leading causes that constantly progress to life hanging anemia when detainments in care do. Systemic challenges including dearths of professed providers, lack of blood products, exigency transport, and limited individual tools significantly worsen issues. Strengthening health systems, perfecting access to uterotonics, enhancing community mindfulness, and establishing dependable blood force chains are essential strategies to reduce preventable motherly deaths. Prioritizing motherly health investment and exigency obstetric readiness can mainly reduce the global burden of APHA.
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