PPH leading to unnecessary deaths

Teenage girls in Tanzania.jpg

Women across the globe are dying unnecessarily due to excessive bleeding after childbirth, in some of the poorest and most under-resourced regions.

Sadly, hemorrhage is the leading direct cause of maternal mortality, accounting for 27.1% of maternal deaths worldwide. More than two thirds of reported hemorrhage deaths were classified as postpartum hemorrhage (PPH).

PPH occurs in all settings. Most women who die from PPH have no risk factor, so the belief that screening for high risk women to deliver in specialised facilities is not an effective strategy. Instead, all women should have immediate access to quality care, including first line PPH management: availability of all essential drugs, supplies and equipment wherever they deliver.

While easily addressed in many countries of the world, effective treatment is not always available at all settings, particularly when there are delays in referral, or a woman is unable to access quality care from skilled health personnel.

Sub-Saharan Africa remains the region with the highest ratio or maternal mortality, at 555 per 100, 000 live births – almost triple that of the next highest. Demonstrating that, despite a worldwide decline of 44% in maternal deaths between 1990 – 2015, there is still a long way to go to meet the new Sustainable Development Goals (SDGs) 2015 - 2030 target to reduce the global maternal mortality ratio to less than 70 per 100 000 live births, with no country having a maternal mortality rate of more than twice the global average. 

Women who hemorrhage while pregnant or around the time of delivery are at high risk of dying because once bleeding has started, death can occur within two hours. Key interventions to reduce maternal deaths from severe blood loss are access to drugs such as misoprostol and oxytocin. These should always be considered as the first option for treatment of PPH. FIGO’s Postpartum Hemorrhage Initiative aims to expand strategies and interventions to prevent and treat PPH, disseminating evidence-based information on the use of misoprostol.

Effective management of PPH should be started ideally within the first hour of delivery and preferably less than 30 minutes after delivery, yet for many women, especially those who give birth outside of health facilities or in lower-resource settings, access to treatment is not possible.

In cases where blood transfusions are required, it is crucial to address the need for blood as early as possible. There is, however, a vast difference in the level of access to blood between low and high-income countries. At least 26% of PPH deaths are thought to result from the lack of a blood transfusion.

If we are to provide appropriate quality of care to the most vulnerable women at risk from PPH. FIGO member societies are invited to call upon regulatory agencies and policy-makers to ensure that international guidance on PPH management is taken into account at a national level and that evidence-based policies are adopted.

Today, we look towards a future where countries are strengthened with the means to prevent deaths from PPH.