الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Despite availability of knowledge on determinants, causes, and effective clinical and public health strategies (Ronsmans et al.,2006) acknowledging that a substantial proportion of maternal deaths are preventable, the goal of reducing the maternal mortality ratio (MMR) between 1990 and 2015 by three quarters was not achieved.
This was occurred despite that maternal and newborn health has received scrutinized attention from International bodies, national governments, non-governmental organizations, and the societies (every women and ever child organization web page). Improving maternal health as one of the Millennium Development Goal (MDG 5) is the least likely to be achieved especially in the developing low source African and some Asian countries (gates foundation web page).
Several factors interplay for non-achieving MDG5 goal in these countries, the least is the foundation of valid, accurate and comprehensive data (Danel et al.,2011) enable effective response that may prevent future deaths. Health disparity is another dilemma that heralds the availability of effective health services including emergency to those most in need especially in rural areas and frontiers. This is exponentially augmented by high illiteracy rate, non-affordable costs and shortage in trained manpower (Gilmore et al.,2012).
Effective, low-cost interventions are available, but they are not reaching all women and neonates in need, many women deliver at home and rarely seen by a trained healthcare provider before or after delivery. In addition, the scarcity of skilled providers in poor countries which often coupled with lack to access to current management tools is another major barrier towards reduction of MMR in the developing countries .
Egypt is not exceptional and suffers the same political setbacks affecting support of health programs, resources-related issues, and manpower problems that slow its strides towards achieving the Millennium Development Goals.
We conclude that vital managerial change is required; including formulation of therapeutic protocols for primary obstetric health care services. Without these, our efforts will be useless, with little impact on saving women’s lives.
In our study, The incidence of PPH at was Minia University maternity hospital(1.88 %)at 2015 , (1.69%) at 2016 during the study period, lower than that reported elsewhere in similar setting in the literature.
This study show 22% of the cases had an identifi¬able risk factor for developing primary PPH. The most identifiable risk factor for primary PPH was anemia. It is very important to note that 74% of women had no identifiable risk factor for developing PPH, neces¬sitating that the attending clinicians must always be well prepared to deal with this condition that can cost so many precious lives. The provision of safe and effective delivery care for all women in poor countriesremains difficult, resulting in the continu¬ation of avoidable maternal deaths from PPH (Walraven et al.,2008).
Future studies should involve the effect on maternal outcomes of postpartum hemorrhage following widespread. Chances are the world may turn a corner on these truely astonishing and appalling statistics on our young mothers dying of a preventable cause in the twenty-first century.
The World Bank in 2010 (Samual Mills,2010) has recently reemphasized the importance of periodic maternal audits and review of maternal deaths –similar to this effort- at the facilities’ level.
The need to have in place periodic drills for the management of obstetric hemorrhage, training of junior staff members, periodic auditing of medical records, stricter liaison with senior anesthetist in managing and discussing maternal mortality cases and reports as well as application of evidence based guidelines and protocols for management of all obstetric emergencies recommended.