BJOG: The prevention and treatment of postpartum haemorrhage

‘Postpartum haemorrhage (PPH) remains the most common cause of maternal mortality worldwide.[1] It is responsible for around 30% of maternal deaths, equivalent to 86 000 deaths per year annually or ten deaths every hour…’

Below is the citation and abstract of a review in the January 2015 issue of BJO – An International Journal of Obstetrics and Gynaecology. The full text is available here:

I was particularly struck by the following statement, in the full text:

‘How best to deliver emergency care

In 2005 Hussein called for the development of ‘obstetric first aid’ skills and for its training in the community to be given as much priority as cardiopulmonary resuscitation.[57] Sadly, a decade later, little has progressed in achieving this aim and there is no agreed, coherent first-aid strategy for PPH…’

This suggests a serious failure of global health research translation and I would like to invite comment from HIFA members. As previously discussed on HIFA, the World Health Organization, among others, have provided guidance on emergency care for PPH: WHO recommendations for the prevention and treatment of postpartum haemorrhage (2012).  

Is this guidance not agreed and/or coherent?

CITATION: Weeks, A. The prevention and treatment of postpartum haemorrhage: what do we know, and where do we go to next? BJOG: An International Journal of Obstetrics & Gynaecology. 2015. 122; 2: 202-210.

ABSTRACT: Postpartum haemorrhage (PPH) remains a major cause of maternal deaths worldwide, and is estimated to cause the death of a woman every 10 minutes. This review presents the latest clinical advice, including new evidence on controlled cord traction, misoprostol, and oxytocin. The controversy around the diagnosis of PPH, the limitations of universal prophylaxis, and novel ways to provide obstetric first aid are also presented. It ends with a call to develop high-quality front-line obstetric services that can deal rapidly with unexpected haemorrhages as well as minimising blood loss at critical times: major abruption, placenta praevia, and caesarean for prolonged labour.

Best wishes, Neil

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