Postpartum Hemorrhage (PPH)

Misoprostol for safe motherhood: one tablet, two life-saving indications

Amy Grossman
Alisha Graves
Emmanuel Rwamushaija
Calandra Park
2010

Misoprostol is a safe, acceptable, feasible, and effective alternative for both postpartum hemorrhage (PPH) and the treatment of incomplete abortion and miscarriage when no other interventions are available, which is often the case in resource-challenged regions. This article reviews the use of misoprostol for these two leading causes of maternal death globally and presents data on the implementation of misoprostol for PPH in Zanzibar as a case study. An evaluation was conducted to assess the uptake of misoprostol in public facilities in Zanzibar through a record review at nine facilities...

Maternal mortality: one death every 7 min

Ndola Prata
Malcolm Potts
Nuriye Nalan Sahin-Hodoglugil
2010

This comment in the explores the role of policy and research in using the prevention of postpartum hemorrhage and suggest a joint meeting by WHO and FIGO to revisit the 2009 statement by WHO which does not recommend the use of misoprostol at the community level.

Download PDF, click here.

Setting priorities for safe motherhood interventions in resource-scarce settings

Ndola Prata
Amita Sreenivas
Fiona Greig
Julia Walsh
Malcolm Potts
2010

Objective: Guide policy-makers in prioritizing safe motherhood interventions.

Methods: Three models (LOW, MED, HIGH) were constructed based on 34 sub-Saharan African countries to assess the relative cost-effectiveness of available safe motherhood interventions. Cost and effectiveness data were compiled and inserted into the WHO Mother Baby Package Costing Spreadsheet. For each model we assessed the percentage in maternal mortality reduction after implementing all interventions, and optimal combinations of interventions given restricted budgets of US$ 0.50, US$ 1.00, US$ 1.50 per...

Maternal mortality in developing countries: challenges in scaling-up priority interventions

Ndola Prata
Paige Passano
Amita Sreenivas
Caitlin Elisabeth Gerdts
2010

Although maternal mortality is a significant global health issue, achievements in mortality decline to date have been inadequate. A review of the interventions targeted at maternal mortality reduction demonstrates that most developing countries face tremendous challenges in the implementation of these interventions, including the availability of unreliable data and the shortage in human and financial resources, as well as limited political commitment. Examples from developing countries, such as Sri Lanka, Malaysia and Honduras, demonstrate that maternal mortality will decline when...

Prevention of postpartum hemorrhage at home birth in Afghanistan

Harshadkumar Sanghvi
Nasratullah Ansari
Ndola Prata
Hannah Gibson
Aftab T. Ehsan
Jeffrey M. Smith
2010

Objective To test the safety, acceptability, feasibility, and effectiveness of community-based education and distribution of misoprostol for prevention of postpartum hemorrhage at home birth in Afghanistan. Methods A nonrandomized experimental control design in rural Afghanistan. Results A total of 3187 women participated: 2039 in the intervention group and 1148 in the control group. Of the 1421 women in the intervention group who took misoprostol, 100% correctly took it after birth, including 20 women with twin pregnancies. Adverse effect rates were unexpectedly lower in the...

Where There Are (Few) Skilled Birth Attendants

Ndola Prata
Paige Passano
Tami Rowen
Suzanne Bell
Julia Walsh
Malcolm Potts
2011

Recent efforts to reduce maternal mortality in developing countries have focused primarily on two long-term aims: training and deploying skilled birth attendants and upgrading emergency obstetric care facilities. Given the future population-level benefits, strengthening of health systems makes excellent strategic sense but it does not address the immediate safe-delivery needs of the estimated 45 million women who are likely to deliver at home, without a skilled birth attendant. There are currently 28 countries from four major regions in which fewer than half of all births are attended by...

Inability to predict postpartum hemorrhage: insights from Egyptian intervention data

Ndola Prata
Sabry Hamza
Suzanne Bell
Deborah Karasek
Farnaz Vahidnia
Martine Holston
2011

Knowledge on how well we can predict primary postpartum hemorrhage (PPH) can help policy makers and health providers design current delivery protocols and PPH case management. This article, published in BMC Pregnancy & Childbirth, demonstrates that no single factor can reliably predict the risk of hemorrhage after delivery and therefore supports the development of research, policy work and scale-up of prevention efforts for PPH.

Read full article...

Criticism of misguided Chu et al. article

Malcolm Potts
Caitlin Gerdts
Ndola Prata
Friday Okonofua
Nuriye Hodoglugil
Nap Hosang
Karen Weidert
Ashley Fraser
Suzanne Bell
2012

Chu, Brhlikova and Pollock’s article suggests the WHO rethink its decision to include misoprostol on the Essential Medi- cines List. Their paper is a sad example of workers in an elite setting advocating policies with the potential to endanger the lives of thousands of vulnerable women in low-resource settings.

Published in Journal of the Royal Society of Medicine 2012: 105(11), 454.

...

Training traditional birth attendants to use misoprostol and an absorbent delivery mat in home births

Ndola Prata
Abdul Quaiyum
Paige Passano
Suzanne Bell
Daniel D Bohl
Shahed Hossain
Ashrafi Jahan Azm
Mohsina Begum
2012

A 50-fold disparity in maternal mortality exists between high- and low-income countries, and in most contexts, the single most common cause of maternal death is postpartum hemorrhage (PPH). In Bangladesh, as in many other low-income countries, the majority of deliveries are conducted at home by traditional birth attendants (TBAs) or family members. In the absence of skilled birth attendants, training TBAs in the use of misoprostol and an absorbent delivery mat to measure postpartum blood loss may strengthen the ability of TBAs to manage PPH. These complementary interventions were tested in...

Preventing Postpartum Hemorrhage at the Community Level: A Compendium of Operations Research

Ndola Prata
Martine M. Holston
2013

VSI in collaboration with local and international partner organizations conducted operations research (OR) across seven countries in Africa and Asia to determine the feasibility, acceptability, and program effectiveness of misoprostol use to prevent postpartum hemorrhage (PPH) at the community level. Developed for policy makers, stakeholders and researchers, the compendium includes an overview of the basic components of the OR model, country program summaries, and cross-cutting results and best practices to contribute to the growing evidence base on the community-level use of...