Knowledge, Attitudes, and Practices of Nurses Regarding Uterine Massage for Preventing Postpartum Hemorrhage in a Tertiary Care Hospital

Abstract

Background: Postpartum hemorrhage (PPH) remains the leading cause of maternal mortality worldwide, with uterine atony as the most common etiology. Uterine massage, a core component of the Active Management of the Third Stage of Labor, is a low-cost and non-pharmacological intervention that can prevent PPH, particularly in low-resource settings. Despite its proven effectiveness, gaps persist between theoretical knowledge and routine clinical application among frontline healthcare providers. Objective: This study aimed to assess the knowledge, attitudes, and practices of nurses regarding uterine massage for the prevention of PPH in a tertiary care hospital in Peshawar, Pakistan. -Methods: A descriptive cross-sectional study was conducted among 60 registered nurses with at least one year of experience. Data were collected using a structured questionnaire adapted from a validated tool and analyzed using SPSS version 27. Associations between knowledge, attitudes, practices, and training status were evaluated using chi-square tests, with odds ratios and 95% confidence intervals reported. Results: Overall, 75% of participants demonstrated good knowledge and 78.3% expressed positive attitudes toward uterine massage, but only 60% reported consistent practice. Formal training was significantly associated with higher knowledge (OR = 3.2, 95% CI: 1.1–9.1, p = 0.028), and good knowledge predicted consistent practice (OR = 2.9, 95% CI: 1.0–8.2, p = 0.041). Documentation was poor, with only 38.3% routinely recording uterine massage. Conclusion: Although nurses showed adequate knowledge and favorable attitudes, practice was inconsistent due to limited training and weak documentation. Implementing mandatory simulation-based training and standardized documentation systems may bridge this knowledge–practice gap and strengthen PPH prevention strategies