Prevention of Postpartum Hemorrhage - PowerPoint PPT Presentation

Loading...

PPT – Prevention of Postpartum Hemorrhage PowerPoint presentation | free to view - id: 4c14d-MmJkZ



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Prevention of Postpartum Hemorrhage

Description:

More then 500ml (sever PPH 1,000ml) During the third stage of labor. Period between birth of the infant and delivery ... Most PPH is caused by uterine atony ... – PowerPoint PPT presentation

Number of Views:2063
Avg rating:3.0/5.0
Slides: 20
Provided by: LHamb
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Prevention of Postpartum Hemorrhage


1
Prevention of Postpartum Hemorrhage
Mary Ellen Stanton USAID CSHGP Conference Septembe
r 14, 2004
2
What is Postpartum Hemorrhage?
  • Excessive bleeding
  • More then 500ml (sever PPH gt1,000ml)
  • During the third stage of labor
  • Period between birth of the infant and delivery
    of the placenta

3
Third Stage of Labor Characteristics
  • First Stage labor
  • Second Stage full dilatation of cervix to
    delivery of the infant
  • After childbirth the muscles of the uterus
    contract and placenta begins to separate from the
    uterine wall.
  • The amount of blood lost depends on how quickly
    placenta separation and delivery occurs.
  • If the uterus does not contract normally, the
    blood vessels at the placenta site do not
    adequately contract and severe bleeding results.
  • Source Adapted from Harshad Songhvi,
    MNH/JHPIEGO, 2004

4
What are the causes of PPH?
  • Delayed separation and delivery of the placenta
  • Failure of the uterus to contract
  • Other causes of bleeding
  • Uterine rupture
  • Tears
  • Surgery (C-section, Episiotomy)

5
Why focus on preventing postpartum hemorrhage
(PPH)?
  • Hemorrhage is the largest direct cause of
    maternal death 25-50 of all maternal deaths
  • PPH is mostly unpredictable
  • Most PPH is caused by uterine atony
  • Active management at the third stage of labor can
    prevent 60 of postpartum hemorrhage
  • Evidence-based, feasible, low-cost interventions
    exist
  • Preventing PPH will significantly reduce maternal
    mortality and morbidity

6
What can be done to prevent PPH?
  • Skilled birth attendants can implement
  • active management of the third stage of labor
    through
  • Administering a uterus-contracting drug, e.g.
    Oxytocin, Misoprostol within one minute of birth
  • Applying controlled cord traction and counter
    traction to the uterus
  • Massaging the fundus of the uterus through the
    abdomen
  • Monitoring for further signs of bleeding

7
Procedure for Active Management
  • Palpate abdomen to rule out presence of another
    baby
  • Within 1 minute of birth, give oxytocin 10 IU IM
  • Await strong uterine contraction (2-3 minutes)
  • Apply controlled cord traction while applying
    countertraction above pubic bone
  • If placenta does not descend, stop traction and
    await next contraction
  • After placental delivery, rub uterus fundus
    gently every 15 minutes for 2 hours to ascertain
    it is contracted

Source MCPC, WHO 2002
8
Benefits of Active Management of the Third Stage
of Labor
  • Reduces incidence of PPH by 60
  • Reduces the quantity of blood loss
  • Reduces the use of blood transfusion

9
Maternal Outcomes of Active Management Trials
Source McMormick, Sanghvi, Kinzie, McIntosh,
IJGO2003.
10
Issue Two Methods of Third Stage Management
  • Physiological (expectant) management.
  • Uterotonics are not used.
  • Placenta is delivered by gravity or maternal
    effort.
  • Cord is clamped after delivery of the placenta.
  • Active Management.
  • Uterotonic (drug that contracts the uterus) is
    given as soon after birth of anterior shoulder as
    possible.
  • As soon as the uterus contracts, placenta is
    delivered by controlled cord traction (CCT) with
    counter-traction on the uterus through the
    abdomen.
  • Source Adapted from Harshad Songhvi,
    MNH/JHPIEGO, 2004

11
Active Versus Expectant Management
Clinical estimation generally thought to be
underestimates by about 34-50
Oxytocin, ergometrine or both IM/IV
Prendiville, Elbourne, McDonald, The Cochrane
Library issue 3, 2003
12
Issue Requirements of Active Management of the
Third Stage of Labor
  • Oxytocics and items needed for injection
  • Requires a birth attendant with skills in
  • observation
  • giving an injection
  • controlled cord traction
  • Source Adapted from Harshad Songhvi,
    MNH/JHPIEGO, 2004

13
Other Ways to Reduce Postpartum Blood Loss
  • Prevent prolonged and obstructed labor
  • Many providers dont use the partograph
  • Avoid episiotomy
  • Some providers perform episiotomy routinely

14
Uterotonic Drugs
15
Global Health Postpartum Hemorrhage Special
Initiative, 2003
ETHIOPIA 99 providers trained 24 service sites
National Coverage 6 55
16
  • International Confederation of Midwives Internatio
    nal Federation of Obstetricians Gynecologists
  • Joint Statement - Management of the Third Stage
    of Labour to Prevent Postpartum Hemorrhage
  • Active management of the third stage of labor
    should be offered to women
  • Every attendant at birth needs to have the
    knowledge, skills and critical judgment… and
    access to needed supplies and equipment

17
Lessons from Targeted PPH Programs in Africa 1
  • Focus on PPH prevention resonates with policy
    makers and providers it gets attention,
    energizes stakeholders and gets action
  • Nevertheless, there may be resistance some need
    to be convinced
  • It is important to identify receptivity and find
    champions
  • There is great variation in the way providers
    practice even with up-to-date standards of care
  • Letters/memos from MOH supportive of new PPH
    prevention policies are very helpful

18
Lessons from Targeted PPH Programs in Africa 2
  • Cold chain solutions differ by country
  • Training to competency is shorter if the norm is
    some form of active vs. physiologic management of
    the third stage of labor so training models
    should vary
  • Flexible non-dogmatic approaches are essential
    for clinical care as well as program elements
  • With scarce financial resources, it is important
    to link with existing systems and resources

19
Take-home Messages
  • Postpartum Hemorrhage is the largest direct cause
    of maternal death
  • Active management of the third stage of labor
  • can prevent 60 of postpartum hemorrhage
  • can be modified to the home birth setting
  • Putting the spotlight on postpartum hemorrhage
    prevention will
  • Reduce anemia
  • Reduce emergencies
  • Reduce need for transfusion
  • Reduce maternal mortality
About PowerShow.com