Reproductive Health Agencies Call For A Major Shift In Diagnosis And Treatment Of Postpartum Hemorrhage

Through landmark caller guidelines released today, starring reproductive wellness agencies are calling for a awesome displacement successful really postpartum hemorrhage (PPH) is prevented, diagnosed and treated. The recommendations item nan urgent request for earlier discovery and faster involution – steps that could prevention nan lives of tens of thousands of women each year.

Defined arsenic excessive bleeding aft childbirth, PPH affects millions of women annually and causes astir 45 000 deaths, making it 1 of nan starring causes of maternal mortality globally. Even erstwhile not fatal, it tin lead to lifelong beingness and intelligence wellness impacts, from awesome organ harm to hysterectomies, worry and trauma.

Postpartum hemorrhage is nan astir vulnerable childbirth complication since it tin escalate pinch specified alarming speed. While it is not ever predictable, deaths are preventable pinch nan correct care. These guidelines are designed to maximize effect wherever nan load is highest and resources are astir constricted – helping guarantee much women past childbirth and tin return location safely to their families."

Dr. Jeremy Farrar, Assistant Director-General for Health Promotion and Disease Prevention and Care

New diagnostic criteria for accelerated action

Published by nan World Health Organization (WHO), nan International Federation of Gynecology and Obstetrics (FIGO) and nan International Confederation of Midwives (ICM), nan guidelines present caller nonsubjective diagnostic criteria for detecting PPH, based connected nan largest study connected nan taxable to day – besides published coming successful The Lancet.

Many PPH cases hap without identifiable consequence factors, meaning early discovery and accelerated consequence is critical. Yet successful galore settings, particularly wherever healthcare resources and labour wards are overstretched, delays successful curen consequence successful devastating consequences.

Typically, PPH has been diagnosed arsenic a humor nonaccomplishment of 500 mL aliases more. Now, clinicians are besides advised to enactment erstwhile nan humor nonaccomplishment reaches 300 mL, and immoderate abnormal captious signs person been observed. To diagnose PPH early, doctors and midwives are advised to show women intimately aft commencement and usage calibrated drapes – elemental devices that cod and accurately quantify mislaid humor – truthful that they tin enactment instantly erstwhile criteria are met.

The guidelines urge nan contiguous deployment of nan MOTIVE bundle of actions erstwhile PPH has been diagnosed. This includes:

• Massage of nan uterus;
• Oxytocic narcotics to stimulate contractions;
• Tranexamic acerb (TXA) to trim bleeding;
• Intravenous fluids;
• Vaginal and genital tract examination; and
• Escalation of attraction if bleeding persists.

In uncommon cases wherever bleeding continues, nan guidelines urge effective interventions specified arsenic room aliases humor transfusion to safely stabilize a woman's information until further curen becomes available.

"Women affected by PPH request attraction that is fast, feasible, effective and drives advancement towards eliminating PPH-related deaths," said Professor Anne Beatrice Kihara, President of FIGO. "These guidelines return a proactive attack of readiness, nickname and response. They are designed to guarantee real-world effect – empowering wellness workers to present nan correct care, astatine nan correct time, and successful a wide scope of contexts."

Reducing risks done effective prevention

The guidelines stress nan value of bully antenatal and postnatal attraction to mitigate captious consequence factors specified arsenic anaemia, which is highly prevalent successful low- and lower-middle income countries. Anaemia increases nan likelihood of PPH and worsens outcomes if it occurs. Recommendations for anaemic mothers see regular oral robust and folate during gestation and intravenous robust transfusions erstwhile accelerated correction is needed, including aft PPH, or, if oral therapy fails.

The publication besides discourages unsafe practices specified arsenic regular episiotomies while promoting preventive techniques for illustration perineal massage successful precocious pregnancy, truthful arsenic to trim nan likelihood of trauma and terrible bleeding aft birth.

During nan 3rd shape of labour, nan guidelines urge administering a quality-assured uterotonic to support uterine contraction, preferably oxytocin aliases heat-stable carbetocin arsenic an alternative. If intravenous options are not disposable and nan acold concatenation is unreliable, misoprostol whitethorn beryllium utilized arsenic a past resort.

"Midwives cognize first-hand really quickly postpartum hemorrhage tin escalate and costs lives," said Professor Jacqueline Dunkley-Bent OBE, ICM's Chief Midwife. "These guidelines are a game-changer. But to extremity preventable deaths from PPH, we request much than grounds and protocols. We telephone connected governments, wellness systems, donors, and partners to measurement up, adopt these recommendations, adopt them quickly, and put successful midwives and maternal attraction truthful that postpartum hemorrhage becomes a calamity of nan past."

The guidelines are accompanied by a suite of training and implementation resources, developed pinch partners including UNFPA. These devices dwell of applicable modules for frontline wellness workers, national-level guides for introducing caller practices, and simulation-based training to fortify emergency response.

These consolidated guidelines – nan first to uniquely attraction connected PPH – are being launched astatine nan 2025 FIGO World Congress successful Cape Town, South Africa. They are a important measurement successful nan implementation of nan Global roadmap to combat postpartum hemorrhage betwixt 2023 and 2030.