INTRODUCTION
Reducing maternal mortality is a major focus worldwide. It was estimated that about 830 maternal deaths occurred every day around the globe in 2015, roughly 303 000 per year; 95% of the deaths have occurred in lowincome countries and over 60% in Sub Saharan Africa [1]. Globally, 75% of maternal deaths are caused by the following 5 complications: hemorrhage, infections, preeclampsia and eclampsia, obstructed labor, and abortions [1]. This is similar to the situation of Rwanda where these 5 common causes of maternal mortality in Rwanda have remained the same for the last 6 years. In 2016, Postpartum hemorrhage (PPH) and sepsis accounted for 46% of maternal deaths in Rwanda; more than 70% of deaths occurred in teaching and district
hospitals, and 64% of deaths occurred during the postpartum period [2].
Rwanda has achieved the Millennium Development Goal (MDG) 5 by decreasing the maternal mortality rate (MMR) dramatically from 1071 in 2000 to 210 per 100,000 live births in 2015 [3,4]. However, this is still
unacceptably high in comparison to the MMR in high-income countries
