الفهرس 
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Abstract
Postpartum hemorrhage is the first leading cause of maternal morbidity and mortality worldwide. Maternal death from PPH is a key maternal health indicator and directly reflects care provided during the intrapartum and postpartum periods. Nurses are central to the effective prevention, early recognition and treatment of PPH. They play an important role in monitoring, assisting with measures to control bleeding, providing support to women and their families as well as providing health education for those women. The current study aimed to assess nurses’ compliance with standardized protocol for reduction of post-partum hemorrhage. A descriptive cross sectional research design was utilized. The study was conducted at labor and delivery unit and post-partum departments of Mansoura University Hospital, Mansoura city, Egypt. The study subject included all nurses (105) who are working at labor and post-partum units of Mansoura University Hospital. Three tools were used to collect necessary data which included; Tool (I) Structured Interview Schedule: This tool was developed by the researcher after passing through an extensive and relevant review of literature. The tool consisted of two main parts: The first part to assess general characteristics of the nurses as age, level of education, working setting, employment position, years of experience and daily working hours. The second part concerned with assessment of PPH training programs as the number of PPH training programs, time elapsed since the last training program and the agency provided those programs. Tool (II) Nurses’ Knowledge about postpartum hemorrhage: A self-administered questionnaire was adapted from (Elhabashy & Hafez, 2019) and modified by researcher to assess nurses’ knowledge about PPH. It entailed a total of 30 closed questions; the first 10 general questions about PPH; the second 10 questions discussed nurses’ role during third stage of labor; and the last 10 questions discussed nurses’ role during early postpartum period. Tool (III) Post-Partum Hemorrhage Observational Checklist: An observational checklist was adopted by the researcher from Dorji (2016) and Mathai et al., (2012) to assess nurses’ compliance with standardized protocol for reduction of primary postpartum hemorrhage. It included items grouped into two main sections as follow: Nurse’s compliance during third stage of labor (8 items) and nurse’s compliance during early postpartum period (13items). Nurses’ compliance with each item of the standardized protocol was scored as: completely done (3); incompletely done (2) and not done (1). Results The present study findings revealed that; More than half of maternity nurses have an average level of knowledge about post-partum hemorrhage and about one third of them have a poor knowledge. -As regards to maternity nurses’ compliance with the standardized protocol for reduction of PPH during the third stage of labor, the findings of current study showed that • The majority of maternity nurses didn’t comply with the examination of placenta after delivery. • Nearly three quarters of them didn’t comply with late cord clamping. • More than half of them didn’t comply with controlled cord traction during third stage of labor. -In relation to maternity nurses’ compliance with standardized protocol for reduction of PPH during early post-partum period, our results revealed that • More than three quarters of maternity nurses didn’t comply to relieve maternal anxiety. • Nearly three quarters of them didn’t comply to examine lochia. There was a statistically significant difference between maternity nurses’ knowledge level and their age, educational level, employment position, years of experience and PPH training programs, which means the older nurses, the higher the educational level, the head nurses, the more years of experience & attendance of PPH training programs, the higher knowledge level of nurses. Also, there was a statistically significant difference between maternity nurses’ educational level, years of experience, PPH training programs and their compliance with standardized protocol for reduction of PPH during third stage of labor and early postpartum period which means the higher the educational level, the more years of experience & attendance of training programs, the better compliance with the standardized protocol for reduction of PPH. Based on the present study findings, it is concluded that, about three quarters of maternity nurses had a fair level of compliance with standardized protocol for reduction of PPH during third stage of labor while less than two thirds of maternity nurses have an average level of compliance with the standardized protocol for reduction of PPH during early post-partum period. There was a statistically significant difference between maternity nurses’ knowledge level and their practice level during third stage of labor and early post-partum period, means that, maternity nurses who had good PPH knowledge were betterly complied with the standardized protocol for reduction of PPH. In the light of the present study findings, the following can be recommended. • Conducting mandatory periodical training workshops for maternity nurses to update their knowledge and practices regarding PPH prevention and management. • Applying standard guideline for PPH management to be implemented in different health care setting to maintain and provide high quality of health care regarding third and fourth stage of labor. • Designing simple booklets and handouts with updated knowledge and practices about management of labor and PPH. Further research studies : • Assess factors hindering maternity nurses’ compliance with standardized protocol for reduction of PPH. • Assess the effect of applying PPH training programs on maternity nurses’ knowledge and practices related to PPH management.