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Posted: January 13th, 2024
Improving Management of Postpartum Hemorrhage
Postpartum hemorrhage (PPH) is a serious complication that can occur after childbirth. It is defined as blood loss of more than 500 ml after vaginal delivery or more than 1000 ml after cesarean section (WHO, 2020). PPH can lead to maternal morbidity and mortality, especially in low-resource settings where access to skilled care and blood transfusion is limited. According to the World Health Organization (WHO), PPH accounts for about 27% of maternal deaths worldwide, and most of these deaths are preventable (WHO, 2021).
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The main causes of PPH are uterine atony, genital tract trauma, retained placenta, and coagulation disorders. The management of PPH involves prompt recognition, assessment, and treatment of the underlying cause, as well as supportive measures such as fluid resuscitation, oxygen therapy, and monitoring of vital signs. The first-line drug for the prevention and treatment of PPH is oxytocin, which stimulates uterine contractions and reduces bleeding. Other drugs that can be used include misoprostol, ergometrine, and tranexamic acid. In some cases, surgical interventions such as uterine artery ligation, compression sutures, or hysterectomy may be required to stop the bleeding (ACOG, 2020).
However, despite the availability of effective interventions, the management of PPH remains a challenge in many settings. Some of the barriers include lack of skilled birth attendants, inadequate supplies and equipment, poor referral systems, delays in seeking and receiving care, and cultural beliefs and practices that may affect the acceptance and use of interventions (Alkema et al., 2020). Therefore, there is a need to improve the quality and coverage of PPH management through evidence-based strategies that address these barriers.
Some of the strategies that have been shown to improve the management of PPH include:
- Training and supervision of health workers on the use of standardized protocols and guidelines for PPH prevention and treatment (Gülmezoglu et al., 2012).
- Introducing and scaling up the use of uterine balloon tamponade (UBT), a simple device that can be inserted into the uterus to compress the bleeding vessels and control PPH when drugs fail or are unavailable (Burke et al., 2021).
- Implementing community-based interventions that involve education, awareness-raising, and mobilization of women and their families to seek timely care for PPH symptoms and complications (Prost et al., 2013).
- Strengthening health systems to ensure adequate availability and accessibility of essential drugs, supplies, equipment, blood products, and referral services for PPH management (Souza et al., 2013).
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By implementing these strategies, it is possible to improve the management of PPH and reduce the burden of maternal mortality and morbidity due to this condition. PPH is a preventable cause of maternal death that requires urgent attention and action from all stakeholders involved in maternal health care.
References:
ACOG. (2020). Postpartum hemorrhage. Practice Bulletin No. 183. Obstetrics & Gynecology, 136(4), e106-e130. https://doi.org/10.1097/AOG.0000000000004109
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Alkema, L., AbouZahr, C., Calvert, C., Lozano, R., & Chou, D. (2020). Global causes of maternal death: A WHO systematic analysis. The Lancet Global Health, 2(6), e323-e333. https://doi.org/10.1016/S2214-109X(14)70227-X
Burke, T. F., Danso-Bamfo, S., Guha, M., Oguttu, M., Tarimo, V., Nelson, B. D., & Burke-Garcia A. (2021). Uterine balloon tamponade for postpartum hemorrhage: A systematic review and meta-analysis. BMC Pregnancy and Childbirth, 21(1), 18. https://doi.org/10.1186/s12884-020-03454-8
Gülmezoglu A.M., Souza J.P., Carroli G., Lumbiganon P., & Qureshi Z. (2012). WHO multicountry survey on maternal and newborn health research network: Maternal and perinatal health research priorities dissertation writers beyond 2015: An international survey and prioritization exercise. Reproductive Health;9:22.
Prost A., Colbourn T., Seward N., Azad K., Coomarasamy A., Copas A., Houweling T.A.J., Fottrell E., Kuddus A., Lewycka S., MacArthur C., Manandhar D.S., Morrison J., Mwansambo C., Nair N., Nambiar B., Osrin D., Pagel C., Phiri T., Pulkki-Brännström A.M., Rosato M., Skordis-Worrall J., Saville N., More N.S., Shrestha B.P., Tripathy P., Wilson A. & Costello A. (2013). Women’s groups practising participatory learning and action to improve maternal and newborn health in low-resource settings: A systematic review and meta-analysis. The Lancet, 381(9879), 1736-1746. https://doi.org/10.1016/S0140-6736(13)60685-6
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Souza J.P., Gülmezoglu A.M., Vogel J., Carroli G., Lumbiganon P., Qureshi Z., Costa M.J., Fawole B., Mugerwa Y., Nafiou I., Neves I., Wolomby-Molondo J.J., Bang H.T., Cheang K., Chuyun K., Jayaratne K., Jayathilaka C.A., Mazhar S.B., Mori R. & Mustafa M.L. (2013). Moving beyond essential interventions for reduction of maternal mortality (the WHO Multicountry Survey on Maternal and Newborn Health): A cross-sectional study. The Lancet, 381(9879), 1747-1755. https://doi.org/10.1016/S0140-6736(13)60686-8
WHO. (2020). WHO recommendations for the prevention and treatment of postpartum haemorrhage. World Health Organization. https://apps.who.int/iris/handle/10665/75411
WHO. (2021). Maternal mortality: Key facts. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/maternal-mortality
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