Practical advice on preventing maternal death due to postpartum hemorrhage

Postpartum hemorrhage is the leading cause of maternal death in India. The majority of these cases are preventable, but due to a lack of resources in many settings, maternal death rates in India remain higher than in other developing countries. The national maternal mortality rate in India is 254 per 100,000 live births, an absolute number of 68,000 per year, according to 2008 estimates by UNICEF.1

2014 full bakri balloon More than one-third of all maternal mortality worldwide can be attributed to postpartum hemorrhage. Certain challenges such as the lack of skilled birth attendants, especially in rural areas, can only be fully addressed through a significant increase in resources and infrastructure. However, intermediate steps can be taken to help address this issue by implementing a number of low-cost and minimal technology clinical techniques using widely available medications and devices.

Key Point: Maternal death due to postpartum hemorrhage can be significantly decreased even in settings with minimal resources through 3 primary techniques: active management of third-stage labor; administration of medications to contract the uterus—especially misoprostol when cost, refrigeration, or administration are issues; and intrauterine compression with a balloon-like device, even a foley catheter or condom if needed.

Definition and causes

Acute postpartum hemorrhage is defined as loss of more than 500 cc of blood within 2 hours of a vaginal delivery and acute severe postpartum hemorrhage refers to the loss of more than 1,000 cc of blood in the same time period.2 Hemostasis following delivery is largely dependent on adequate contraction of the uterus. Thus, uterine atony, or the failure of the uterus to contract adequately following delivery due to a loss of muscle tone, is the leading cause of postpartum hemorrhage, resulting in uncontrolled bleeding from the placental bed.

Risk factors for uterine atony include macrosomia, multiple gestation, polyhydramnios, prolonged use of high doses of oxytocin, and delayed delivery of the placenta. However, many cases occur in women who have no identifiable risk factors. Other causes of postpartum hemorrhage include retained placental tissue, cervical and vaginal lacerations, clotting disorders, and uterine rupture.

Low-tech, high success means of preventing hemorrhage

There are a number of approaches to this problem that can be adopted even in settings with...

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This entry was posted in Ob/Gyn, Pharmacology, Primary Care and tagged , , , , , , , , . Volume: .

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