Practical approaches to managing postpartum haemorrhage with limited resources. (November 2019)

• Record Type: Journal Article
• Authors: Fawcus, Susan
• Is Part Of: Best practice & research. Volume 61(2019)
• Page Start: 143
• Page End: 155
• Publication Date: 2019-11
• Subjects: Postpartum haemorrhage -- Limited resources -- Home birth -- Task shifting -- In-facility treatment -- Emergency transport; Gynecology -- Periodicals; Obstetrics -- Periodicals; Genital Diseases, Female; Obstetrics; Gynecology; Obstetrics; Periodicals; 618.05
• DOI: 10.1016/j.bpobgyn.2019.03.009
• Languages: English
• ISSNs: 1521-6934

Abstract

Abstract: Mortality from postpartum haemorrhage (PPH) is higher in low resource settings due to increased incidence, higher case fatality rates and poor general health of the population. The challenges of managing PPH with limited resources are presented. Feasible interventions for preventing and treating PPH for home births are described. Given that maternity care is organised around levels of care in low resource settings, guidance is provided for what measures can be performed to manage PPH at different levels of care (clinic, community health centre, district hospital, regional and central hospital); and by which cadre (midwife, clinical officer, general doctor, specialist). Effective management of PPH requires on-going training and emergency drills. Reducing mortality from PPH is not possible without available urgent transport from home to facility and between levels of care. In addition, the essential building blocks of the health system must be functional to enable effective management of PPH. Highlights: The incidence and mortality of PPH are higher in limited resource settings, which constitutes an infringement of women's right to health. Community initiatives involving community health workers, traditional birth attendants, women's groups and maternity waiting areas can facilitate access to care. Uterotonic drugs can be administered to prevent and treat PPH at home birth, as well as in facility birth. District hospitals must be able to perform laparotomy and conservative surgical measures for intractable PPH. Emergency transport, with temporising treatment for PPH, is essential to enable women to get to the highest level of care when required. Obstetric specialists need to be advocates for improved resources and provide outreach support and training to district facilities that refer to them.