Review of Obstetric Haemorrhage Management Protocols and Practice at Teaching Hospitals in Oyo and Kano States

Obstetric haemorrhage remains the leading direct cause of maternal mortality in Nigeria, and the quality of haemorrhage management protocols and their implementation at the institutional level is a critical factor determining survival. This study reviews the content of obstetric haemorrhage management protocols and their practice concordance at teaching hospitals in Ibadan, Oyo State (South West) and Kano, Kano State (North West). A comparative mixed-methods design is applied, combining structured protocol audits at both institutions against the RCOG and FIGO obstetric haemorrhage management guidelines, with prospective documentation of haemorrhage management in 60 postpartum haemorrhage cases (30 per site) over a four-month observation period. Concordance with protocol recommendations for uterotonic administration timing, bimanual uterine compression, balloon tamponade use, blood transfusion trigger, and surgical escalation is assessed. Structured interviews with 30 obstetric personnel explore implementation barriers. Quantitative concordance rates are computed in SPSS, and qualitative data undergo thematic analysis. Available obstetric haemorrhage quality literature from both zones identifies delayed second uterotonic administration and delayed surgical escalation as the most common practice gaps. The WOMAN Trial findings and the WHO Recommendations for the Prevention of Postpartum Haemorrhage provide the management standard. Findings will support both institutions in updating and operationalising haemorrhage management bundles. Keywords: obstetric haemorrhage, postpartum haemorrhage, management protocols, Oyo State, Kano State.