Save Mothers, Stop PPH

Postpartum hemorrhage (PPH) is the single leading cause of maternal mortality in most countries. A new collaborative effort to improve PPH control is being initiated by FIGO.

Postpartum Hemorrhage quote

A new collaborative effort to improve PPH control is being initiated by FIGO.

Postpartum hemorrhage (PPH) is the single leading cause of maternal mortality in most countries, and its severe effects are often compounded by maternal anemia. The huge global health impact on maternal health by PPH will very likely be changed in coming years, through joint new efforts.

The rapid increase of facility births in the last 20 years, in combination with several new treatment options, makes it possible to save most women  (>90% of those currently dying from PPH) from PPH deaths, even at the health center level, in hands of a midwife or other skilled provider. These treatment options include the Non-Pneumatic Anti-Shock Garment (NASG) the uterine balloon tamponade (UBT), tranexamic acid (TXA) and new uterotonics such as misoprostol and heat-stable carbetocin.

Applying these in a standardised fashion is a promising way forward. In December 2017, WHO held an Expert Consultation on Bundled Approaches to PPH treatment and the experts agreed on two bundles:

  • Initial bleeding:  uterine massage, uterotonics, TXA, IV fluids
  • Refractory bleeding: bimanual massage, aorta compression, NASG, UBT

While individual components of these two bundles may vary slightly between countries and over time, the basic principle of remembering four things at a time to do consistently, is expected to remain. 

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However, implementing this approach requires facility readiness, supply chain improvement, teamwork and communication, network integration (where staff communicate and collaborate between facilities), and local data use for trouble shooting and improvement.

In Kenya and India, a team from Massachusetts General Hospital has developed a promising approach to help maternal health care staff in countries address all of those, driven by the realisation that even severe PPH usually can be treated effectively. This approach supplements the Helping Mothers Survive Bleeding After Birth programme that is already being implemented in countries, with the support of FIGO.

FIGO has received a grant from the Bill & Melinda Gates Foundation to pursue this work in coming years. Prospective work in Bangladesh, Kenya and Uttar Pradesh, India, will be combined with an inclusive partnership and a communication effort. A designated set of webpages will be launched soon and will be accessible through the FIGO website, to reflect lessons learned by all partners working on improved PPH control.

UNICEF has joined the FIGO working group, as well as ICM. FIGO hopes that ICM will join in the leadership of this new initiative.