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The Prevention of Postpartum Hemorrhage in the Community (Souza, 2013)

 

Souza, João Paulo. “The Prevention of Postpartum Hemorrhage in the Community.” PLOS Medicine 10, no. 10 (October 2013): doi:10.1371/journal.pmed.1001525
URL: www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001525

In a commentary accompanying the Stanton study, João Paulo Souza of the Department of Reproductive Health and Research at the World Health Organization emphasizes the importance of the study results, which demonstrate the feasibility and efficacy of administering oxytocin in single dose pre-filled syringes (via the Uniject device) as a means of preventing post-partum hemorrhaging (PPH) during home births. He also describes the challenges that remain for using the oxytocin-filled Uniject in under-resourced communities, particularly the need for a cold supply chain and trained attendants to administer the injection. In light of these challenges, Souza argues that misoprostol remains an important alternative. However, HDN readers should note that some in the pro-life community are concerned about the widespread introduction of misoprostol because of its potential use as a medical abortifacient, particularly in countries where access to abortion is restricted for legal or other reasons.  Souza also argues that for effective management of PPH in the developing world, other interventions, such as adequate availability of comprehensive emergency services, should also be pursued.

 

Space-Age Technology Could Help Cut Maternal Deaths (Guardian)

Neoprene and velcro have been incorporated into an experimental “anti-shock” garment that aims to slow postpartum hemorrhaging. If used in the developing world, the lifewrap, as it is also called, could buy women time to be transported to healthcare facilities with adequate emergency services.

IRIN, “Space-Age Technology Could Help Cut Maternal Deaths” Guardian June 24, 2013.

URL: www.theguardian.com/global-development/2013/jun/24/space-technology-maternal-deaths

Advancing Maternal Survival in the Global Context (Khan, 2013)

 

Khan, Omar, Richard Derman, and Nancy Sloan. “Advancing Maternal Survival in the Global Context: Are Our Strategies Working?” BMC Public Health 13 (2013): 689. doi:10.1186/1471-2458-13-689.

URL: www.biomedcentral.com/1471-2458/13/689

ABSTRACT:

There have been significant gains in improving maternal mortality over the last two decades. Researchers have suggested a variety of interventions and mechanisms to explain these improvements. While it is likely that much of what has been done in research and programs has contributed to this decline, the evidence regarding what works in the settings in which women deliver continues to face many challenges. We review the evidence for these improvements and suggest that there remain areas to focus on, particularly the births which currently take place in an unsupervised or substandard environments. We highlight the main areas where more evidence is needed, and end with a call to determine which of our interventions seem to have the most benefit; which do not; and where to invest future resources.

Khan, et al briefly review advances in maternal survival, particularly in the developing world.  The authors highlight the need for rigorous research into the effectiveness of various interventions and the importance of assessing their effect on maternal mortality as directly as possible through household and mobile device reporting.  As the authors mention, millions of dollars are currently being spent on interventions that have not been critically evaluated.  Understanding which interventions are most effective will help efficiently target scarce resources.

 

Effect on Postpartum Hemorrhage of Prophylactic Oxytocin (10 IU) by Injection by Community Health Officers in Ghana (Stanton, 2013)

 

Stanton, Cynthia, Samuel Newton, Luke Mullany, Patience Cofie, Charlotte Taiah Agyemang, Edward Adiibokah, Seeba Amenga-Etego, Niamh Darcy, Sadaf Khan, Deborah Armbruster, John Gyapong, and Seth Owusu-Agyei. “Effect on Postpartum Hemorrhage of Prophylactic Oxytocin (10 IU) by Injection by Community Health Officers in Ghana: A Community-Based, Cluster- Randomized Trial.” PLOS Medicine 10, no. 10 (October 2013). doi. 10.1371/journal.pmed.1001524.

URL: www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001524

ABSTRACT:

Oxytocin (10 IU) is the drug of choice for prevention of postpartum hemorrhage (PPH). Its use has generally been restricted to medically trained staff in health facilities. We assessed the effectiveness, safety, and feasibility of PPH prevention using oxytocin injected by peripheral health care providers without midwifery skills at home births.

 

Stanton et al conducted a community based cluster-randomized trial in Ghana to assess the efficacy of administering oxytocin to women just after delivery via pre-filled syringes (called the Uniject device) to prevent postpartum hemorrhaging (PPH). The authors found that the rate of PPH was reduced by half when the oxytocin-filled Uniject device was used. Importantly, there were no instances where oxytocin was administered prior to delivery, which would be unsafe for mother and child, and the device was successfully used by unskilled birth attendants during home births. Because over 50% of women in sub-Saharan Africa give birth at home, where the risk of PPH is greatest, the introduction of this intervention could make a significant contribution to maternal survival these areas. See the accompanying commentary by Joao Paulo Souza for a detailed discussion of the advantages and limitations of using the oxytocin-filled Uniject for the prevention of PPH.  HDN readers should note that the Stanton study was funded by PATH who commissioned and patented the Uniject device.

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