Maternal Health

Parachute approach to evidence based medicine

M Potts
N Prata
J Walsh
A Grossman
2006

Waiting for the results of randomised trials of public health interventions can cost hundreds of lives, especially in poor countries with great need and potential to benefit. If the science is good, we should act before the trials are done. Good science, we suggest, is taking the research to the problem rather than conducting the research in the tallest ivory tower the investigator can find. Randomised controlled trials are needed and, when appropriate, should be part of the empirical evidence necessary for decision making. The question is how much evidence is needed to move from research...

The worldwide burden of postpartum haemorrhage: Policy development where inaction is lethal

Malcolm Potts
Anke Hemmerling
2006

This article evaluates the burden of Postpartum hemorrhage, the single most common cause of maternal death and calls for bold new policies.

Abstract: Most maternal deaths occur to women who are not attended by trained health professionals. Postpartum hemorrhage is the single most common cause of maternal death. The delivery of large haemochorial placenta in our species predisposes to heavy bleeding and can be dealt with only by using effective uterotonics. The 1987 Safe Motherhood Initiative has failed to reduce maternal mortality significantly, and shortages of trained personnel...

A global overview of ongoing misoprostol studies

Ndola Prata
2006

Clinical research has the potential to advance knowledge in the use of a technology and to help inform the decision-making process involving the public health benefits of such technology. In the last decade, one of the most important advances in maternal health, with special significance for developing countries, was the research on the gynecological indications of the use of misoprostol. Numerous studies have shown misoprostol’ s efficacy in the management of postpartum hemorrhage (PPH), pregnancy termination, labor induction, and cervical ripening. Its multiple non-parenteral routes of...

Misoprostol and active management of the third stage of labor

N Prata
S Hamza
R Gypson
K Nada
F Vahidnia
M Potts
2006

Objective: To compare current practices for the active management of the third stage of labor (AMTSL) with the use of 600 Ag of oral misoprostol. Methods: An operations research study was designed to compare blood loss with current AMTSL practices and misoprostol use. Results: Women in the misoprostol group were less likely to bleed 500 ml or more (adjusted odds ratio, 0.30; 95% confidence interval, 0.16—0.56) compared with those in the current practices group. In the current practices group 73% women required interventions because of postpartum hemorrhage, compared with 11% in the...

Cost-effectiveness of misoprostol to control postpartum hemorrhage in low-resource settings

S Bradley
N Prata
N Young-Lin
D Bishai
2007

Objective: To test the cost-effectiveness of training traditional birth attendants (TBAs) to recognize postpartum hemorrhage (PPH) and administer a rectal dose of misoprostol in areas with low access to modern delivery facilities.

Method: A cost-effectiveness analysis, modeling two hypothetical cohorts of 10,000 women each giving birth with TBAs: one under standard treatment (TBA referral to hospital after blood loss ≥ 500 ml), and one attended by TBAs trained to recognize PPH and to administer 1000 μg of misoprostol at blood loss ≥ 500 ml.

Result: The misoprostol strategy...

Thousand Year Old Depictions of Massage Abortion

Malcolm Potts
Maura Graff
Judy Taing
2007

Abortion induced by physical trauma has a long history. This article describes bas-relief sculptures in Angkor Wat, Cambodia dating from the 9th to the 12th centuries, and compares them to contemporary observations of massage abortion. The Cambodian carvings, along with two similar representations in Indonesia, are the earliest known illustrations of an abortion in progress. The bas-reliefs prove that abortion techniques were well understood at the time, although their cultural interpretation is uncerain.

Published in Journal of Family Planning and Reproductive Health Care,...

A Textbook of Postpartum Hemorrhage: Chapter 19: Overview of Misoprostol Studies in Postpartum Hemorrhage

A Hemmerling
2006

Tables of peer-reviewed misoprostol studies.

The objective of this book is to bring together within a single volume the most up to date information about the epidemiology, diagnosis and management of postpartum hemmorrhage. Whilst much has been published on the subject a truly comprehensive synthesis of this kind has never before been attempted. This volume sets out, therefore, to provide physicians with an overall clinical perspective that has hitherto been unavailable.

Published in A Textbook of Postpartum Hemorrhage, Sapiens Publishing, October 2006, 18,4-190...

A Textbook of Postpartum Hemorrhage: Chapter 16: Misoprostol in Practice

Malcolm Potts
2006

Chapter 16 in A Textbook of Postpartum Hemorrhage discussing Misoprostol in Practice

“As a low-cost, easy-to-administer, powerful uterotonic with an excellent safety profile and long shelf-life, misoprostol has a revolutionary potential to reduce death and morbidity from postpartum hemorrhage in precisely those situations where it is most common – delivery at home without a skilled birth attendant.”

Published in A Textbook of Postpartum Hemorrhage, Sapiens Publishing, October 2006, 178-179

Download PDF,...

A Textbook of Postpartum Hemorrhage: Chapter 17: Management of Postpartum Hemorrhage at the Community Level

Ndola Prata
2006

Chapter 17 in A Textbook of Postpartum Hemorrhage discussing Management of Postpartum Hemorrhage at the Community Level

The objective of this book is to bring together within a single volume the most up to date information about the epidemiology, diagnosis and management of postpartum hemorrhage. Whilst much has been published on the subject a truly comprehensive synthesis of this kind has never before been attempted. This volume sets out, therefore, to provide physicians with an overall clinical perspective that has hitherto been unavailable.

The ability to manage postpartum...

Saving maternal lives in resource-poor settings: Facing reality

Ndola Prata
Amita Sreenivas
Farnaz Vahidnia
Malcolm Potts
2009

Literature review to identify interventions that require minimal treatment/infrastructure and are not dependent on skilled providers. Simulations were run to assess the potential number of maternal lives that could be saved through intervention implementation according to potential program impact. Regional and country level estimates are provided as examples of settings that would most benefit from proposed interventions.

Three interventions were identified: (i) improve access to contraception; (ii) increase efforts to reduce deaths from unsafe abortion; and (iii) increase access to...