Title: Saving women's lives: evidence-based recommendations for the prevention of postpartum haemorrhage.

POPLINE Document Number: 314827

Author(s):

Mathai M
Gulmezoglu AM
Hill S

Source citation:

Bulletin of the World Health Organization, 2007 Apr;85(4):245-324.

Abstract:

Failure of the uterus to contract adequately after childbirth (atonicity) is the most common cause of postpartum haemorrhage (PPH), the leading cause of maternal death in Africa and Asia. Attempts to identify women at risk of atonic PPH have been unsuccessful. Numerically, more women without risk factors have atonic PPH compared to those with risk factors. To prevent atonic PPH, interventions should therefore be targeted at all women during childbirth. Active management of the third stage of labour has been described as a package comprising the following interlocking interventions: administration of a prophylactic uterotonic after birth of the baby, and usually also early cord clamping and cutting, and controlled cord traction. Other definitions in this package include uterine massage, but without reference to the timing of cord clamping. In contrast, expectant (also called physiological or conservative) management involves waiting for signs of separation and allowing the placenta to deliver spontaneously, or aided by gravity or nipple stimulation. While there is agreement on the beneficial effects of active management of the third stage of labour for prevention of PPH, there is less consensus on issues such as importance of the intervention's individual components, the best methods and the requirements for safe administration of this intervention under conditions of limited resources. In particular, the choice of uterotonics has been the subject of discussion and debate. (excerpt)

Keywords:

Developing Countries
Recommendations
Clinical Research
Postpartum Women
Women in Development
Postpartum
Bleeding
Prevention and Control
Uterus
Treatment
Drugs
Best Practices
Oxytocin
Research Methodology
Puerperium
Reproduction
Economic Development
Economic Factors
Signs and Symptoms
Diseases
Genitalia, Female
Genitalia
Urogenital System
Physiology
Biology
Medical Procedures
Medicine
Health Services
Delivery of Health Care
Health
Programs
Organization and Administration
Pituitary Hormones
Hormones
Endocrine System