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Prevention and Management of Postpartum Hemorrhage in Sub-Saharan Africa: A Summary of the Evidence

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Emeline Mugisha

on 3 April 2011

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Transcript of Prevention and Management of Postpartum Hemorrhage in Sub-Saharan Africa: A Summary of the Evidence

Each year, more than 500,000 women worldwide die from pregnancy- or childbirth-related complications... A loss of 500 ml or more from the genital tract after delivery.
A blood loss of 500 ml or more from the genital tract after delivery. The majority of cases occur within 24 hours after birth. These cases are defined as early (primary) PPH. What is PPH? What are the Causes of Primary (Early) PPH? 1) Uterine atony (relaxation of the uterus) Potential Consequences of PPH Leading Causes of Maternal Death Hypovelmic shock


Risk for transfusion reactions or infection with HIV or hepatitis

Surgery 2) Genital trauma 3) Retained placental fragments 5) Inversion of the uterus (rare) What Can be Done To Prevent PPH? AMTSL (Active Management of Third Stage of Labor) 1) Give 10 IU of oxytocin IM (preferred drug) or other uterotonic agent (ergometrine or misoprostol) within 1 minute after the baby is born 2) Clamp the cord and deliver the placenta by controlled cord traction (gently pulling on the umbilical cord) while stabilizing the uterus 3) Massage the uterus after delivery of the placenta AttendGive iron supplements to anemic women, so that if hemorrhaging occurs, she is more likely to survive. What Can Be Done Earlier in Pregnancy? What If You Don't Have Drugs? 1) Nipple stimulation, baby on breast, and early breastfeeding. 2) Apply pressure on the aorta above the umbilicus (should not be able to feel the femoral pulse). How Can 500 ml of Blood Loss Be Estimated? 2 soaked Kangas or other cotton garments 3) Put mother's legs above her heart level. What if The Mother Still Bleeds? If blood loss is LESS than 50oml:
IV fluids with additional dose of uterotonic drug (i.e. 10-20 IU oxytocin)
if cause cannot be treated transfer to a higher level facility 2) Iron supplements and/or iron-rich foods early in pregnancy if mother is anemic 4) Coagulopathy/
clotting failure (rare) Postpartum Hemorrhage in Sub-Saharan Africa: Strategies to Reduce Maternal Mortality and Morbidity 4) Massage uterus and teach mother to massage uterus. More than 50% of these deaths occur in Sub-Saharan Africa. Unpredictable. Preventable. 1) Prenatal care Where Can You Find Additional Resources on PPH Prevention and Management? References If blood loss is GREATER than 500 ml:
give additional dose of uterotonic drug
transfer woman to higher level facility that can manage shock and provide surgery and/or blood transfusion Even a small amount of blood loss can be life-threatening for anemic women. Alaffia (2011). Maternal Health Project. Retrieved from: http://www.unicef.org/health/index_maternalhealth.html

Kodkany B.S., & Derman R.J. (2006). Pitfalls in Assessing Blood Loss and Decision to Transfer. In A Textbook of Post Partum Hemorrhage: A comprehensive guide to evaluation, management, and surgical intervention (chapter 4). Retrieved from http://www.sapienspublishing.com/

Ladewig, P.A.W, London, M.L., and Davidson, M.R. (2010). Contemporary Maternal-Newborn Nursing Care (7th ed.). New York, New York: PearsonEducation, Inc.

Pathfinder International. Addressing Postpartum Hemorrhage. Retrieved from: http://www.pathfind.org/site/PageServer?pagename=Major_Projects_Continuum_of_Care_Pubs

Prata, N., Mbarukub, G., Campbellc, M., Potts, M., Vahidnia F. (2005) Controlling postpartum hemorrhage after home births in Tanzania. International Journal of Gynecology and Obstetrics. 90: 51-55.

SafeMotherhood.org (2010). Current Initiatives. Retrieved from: http://www.safemotherhood.org/priorities/initiatives.html

UNICEF (2009). Maternal and Newborn Health. Retrieved from: http://www.unicef.org/health/index_maternalhealth.html

World Health Organization (2007). WHO Recommendations for the prevention of postpartum haemorrhage. Geneva, Switzerland: World Health Organization (WHO). Retrieved from: http://www.who.int/making_pregnancy_safer/documents/who_mps_0706/en/index.html

World Health Organization (2006). Managing postpartum haemorrhage. Education materials for teachers of midwifery. 2nd edition. Geneva, Switzerland: World Health Organization (WHO). Retrieved from: http://www.who.int/making_pregnancy_safer/documents/2_9241546662/en/index.html

World Health Organization (2005). Making every mother and child count. Geneva, Switzerland: World Health Organization (WHO). Retrieved from: http://www.who.int/whr/2005/en/index.html

WHO, UNICEF, UNFPA, and The World Bank (2007). Maternal mortality in 2005: estimates developed by WHO, UNICEF, UNFPA and The World Bank. Geneva, Switzerland: World Health Organization (WHO). Retrieved from: http://www.who.int/making_pregnancy_safer/documents/9789241596213/en/

World Health Organization (2011). Making pregnancy safer. Geneva, Switzerland: World Health Organization (WHO). Retrieved from: http://www.who.int/making_pregnancy_safer/topics/maternal_mortality/en/index.html Check for other causes of PPH (e.g. genital lacerations or retained placental fragments) and manage appropriately. Frequently underestimated. Alaffia –Maternal Health Project:
www.alaffia.com UNICEF:
Boite Postale 2110 BrazzavilleRepublic of the Congo
Telephone 242 -281.50.24
Email brazzaville@unicef.org
http://www.unicef.org/health/index_maternalhealth.html Pathfinder International:
http://www.pathfind.org/ World Health Organization (WHO) – Department of Making Pregnancy Safer (MPS):
World Health OrganizationAvenue Appia 201211 Geneva 27Switzerland
Telephone: + 41 22 791 21 11
E-mail: publications@who.int.
Partnership for Safe Motherhood and Newborn Health:
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