Prevention and management of postpartum hemorrhage and hypertensive disorders of pregnancy: results from a 31-country rapid assessment.
The study shows that while key interventions for managing postpartum hemorrhage are available in many countries, significant gaps remain in the integration of newer treatments like heat-stable carbetocin into national guidelines.
Where it sits
this study against the rest of the carbetocin corpusSummary and findings
This study assessed the implementation of evidence-based practices for postpartum hemorrhage (PPH) and hypertensive disorders of pregnancy (HDP) across 31 countries. Key findings included the availability of oxytocin and magnesium sulfate in public and private facilities, as well as the integration of specific interventions like heat-stable carbetocin. The study highlights gaps in national policy guidelines and the need for improved practices.
Abstract
<h4>Background</h4>Postpartum hemorrhage (PPH) and Hypertensive Disorders of Pregnancy (HDP) remain leading causes of maternal death. This multi-country survey asked key informants to assess uptake of evidence-based practices; determine their country's implementation of updated WHO global guidelines; and describe the private sector's role in PPH and HDP management. To our knowledge, this is among the few multi-country assessments to examine national implementation of updated WHO recommendations for PPH and HDP alongside private-sector engagement across three major regions-sub-Saharan Africa, South and Southeast Asia, and Latin America and the Caribbean-providing a comparative view to guide advocacy and programme planning.<h4>Methods</h4>From January to May 2022, 35 countries in sub-Saharan Africa, South and Southeast Asia, and Latin America and the Caribbean were invited to complete a survey (based on 2011 and 2012 surveys) on PPH and HDP management across public and private sectors on PPH and HDP management. Using purposive sampling, country-based focal persons assembled national expert teams from public and private sectors in health policy, education, procurement/distribution, logistics, and information systems to complete the survey. Teams produced consensus-based answers by reviewing nationally available data and policy documents. The Study Team developed composite scores for key quantitative indicators and thematically analyzed qualitative data.<h4>Results</h4>Thirty-one countries completed the survey. Despite significant progress since 2012, several gaps remain. Oxytocin was reported as regularly available in public facilities by 77% of countries and in private facilities by 84% of countries. Magnesium sulfate was reported as available in public facilities by 58% of countries and in private facilities by 45% of countries. Interventions like umbilical vein injection of oxytocin for retained placenta (13% of countries) and heat-stable carbetocin for PPH prevention (45% of countries) were less integrated in national policy guidelines. Since 2011, midwifery scope of practice remained stagnant for manual removal of placenta for PPH, diagnosing severe pre-eclampsia/eclampsia, and giving the loading dose of MgSO4, but 60% of countries in 2022 reported that newer PPH treatments (such as tranexamic acid) were included. Quality assurance systems for procurement of essential drugs and data reporting into national information systems were deficient, particularly in the private sector.<h4>Conclusions</h4>Recommendations include prioritizing integration of updated global guidelines; improving uptake through professional education, mentorship, and supervision; quality assurance; strengthening procurement and supply chains to improve access, availability, and quality of essential drugs and commodities; expanding midwives' scope of practice; and improving private sector governance to enhance reporting of important MNH indicators.
Background
This paper addresses the implementation of updated WHO guidelines for managing postpartum hemorrhage (PPH) and hypertensive disorders of pregnancy (HDP), which are significant contributors to maternal mortality. Previous assessments have highlighted the need for improved practices in these areas, but there is limited comparative data across multiple countries. This study aims to fill that gap by evaluating the current state of practice in 31 countries.
Methods
The study utilized a survey method conducted from January to May 2022, inviting 35 countries to participate. A total of 31 countries completed the survey, which focused on the availability of key interventions for PPH and HDP management in both public and private sectors. The survey included quantitative indicators and qualitative data analyzed thematically.
Results
The primary finding indicates that oxytocin was reported as regularly available in public facilities by 77% of countries (n=31). Additionally, magnesium sulfate was reported available in public facilities by 58% of countries and in private facilities by 45% of countries. Notably, heat-stable carbetocin for PPH prevention was integrated into national policy guidelines by 45% of countries.
Interpretation
While the availability of oxytocin and magnesium sulfate is relatively high, the integration of newer treatments like heat-stable carbetocin remains limited. The effect sizes reported suggest improvements since 2012, but the clinical significance of these findings may be constrained by the gaps in policy integration and the reliance on self-reported data. Confounding factors include the small sample size and potential biases in reporting.
Key findings
- Oxytocin regularly available in public facilities by 77% of countries.
- Oxytocin regularly available in private facilities by 84% of countries.
- Magnesium sulfate available in public facilities by 58% of countries.
- Magnesium sulfate available in private facilities by 45% of countries.
- Heat-stable carbetocin for PPH prevention integrated in national policy guidelines by 45% of countries.
Limitations
- Self-reported data may introduce bias.
- Purposive sampling may not represent all countries equally.
- Limited to 31 countries, not all invited countries participated.
- Focus on availability rather than effectiveness of interventions.
- No longitudinal data to assess changes over time.