CHR Commends WHO For Updating Guidance On Prevention,Treatment Of Postpartum Haemorrhage
The Community Health and Research Initiative (CHR) has commended World Health Organization (WHO) for updating the guidance to prevent Postpartum Hemorrhage, PPH (excessive bleeding after child birth).
The update of the guidance came after two Guidelines Development Group (GDG) meetings which led to four main recommendations and six sub-recommendations on the use of uterotonics for PPH prevention.
According to an article published on the WHO website, every year about 14 million women around the world suffer from postpartum haemorrhage. This severe bleeding after birth is the largest direct cause of maternal deaths. In addition to the suffering and loss of women’s lives, when women die in childbirth, their babies also face a much greater risk of dying within one month compared to babies whose mothers survive.
“This is a good development for improving quality maternal health drugs especially for Africa and Nigeria where maternal death through PPH is very high. While we welcome this new guidance, we therefore call on the Nigerian government to invest in these drugs as it will go a long way in preventing PPH in the country,” says Salisu Musa Muhammad, Executive Director of CHR.
“Shockingly, 99% of the deaths from PPH occur in low- and middle-income countries compared with only 1% in high-income countries although recent studies are showing that it is increasingly an issue of concern for wealthier countries too. It is hoped that with these new guidelines, healthcare workers globally will be able to stop women and their babies from facing unnecessary risks to their health and lives, wherever they live.”
The newly updated recommendations aim to improve the quality of care and health outcomes for women giving birth. The first recommendation is related to the efficacy and safety of uterotonics for the prevention of PPH, and it includes six sub-recommendations. The other three recommendations are related to the choice of uterotonics for PPH prevention.
What the new recommendations say
- Any one of the following uterotonics can be used for the prevention of PPH: oxytocin, carbetocin, ergometrine/methylergometrine, oxytocin and ergometrine fixed-dose combination and misoprostol.
- In settings where multiple uterotonic options are available, oxytocin (10 IU, IM/IV) is the recommended uterotonic agent for the prevention of PPH for all births.
- In settings where oxytocin is not available, or its quality cannot be guaranteed, the use of carbetocin, or if appropriate ergometrine/methylergometrine, or oxytocin and ergometrine fixed-dose combination, or oral misoprostol is recommended.
- Where the quality of oxytocin is considered compromised due to inadequate cold-chain transport and storage conditions, heat-sensitive uterotonic agents such as ergometrine/methylergometrine or oxytocin and ergometrine fixed-dose combination, that have been transported and stored under similar conditions as the oxytocin, are not suitable options. In these situations, heat-stable uterotonic agents (carbetocin or misoprostol) are suitable options depending on the context.
- All the uterotonics recommended for postpartum haemorrhage prevention, can be used in women undergoing vaginal birth or caesarean section, and require, except for misoprostol, a skilled health personnel trained to administer injectable uterotonics.
In line with the above, CHR believes that this is a truly encouraging new development that can revolutionize the ability to keep mothers and babies alive, especially in the developing and African countries where stable electricity to preserve these drugs is inadequate.
We therefore called on President Muhammadu Buhari and the 36 States Governors to invest a certain percentage of the annual health budget for the procurement, storage and distribution of drugs that will prevent postpartum hemorrhage, including carbetocin which is heat stable, to save the lives of mothers and babies.