Prevention and management of postpartum hemorrhage and hypertensive disorders of pregnancy: results from a 31-country rapid assessment.

Oxytocin is regularly available in 77% of public facilities and 84% of private facilities across 31 countries, but integration of some interventions remains low.

Summary and findings

This study assessed the availability and implementation of practices for postpartum hemorrhage (PPH) and hypertensive disorders of pregnancy (HDP) across 31 countries. Oxytocin was reported as regularly available in public facilities by 77% of countries and in private facilities by 84% of countries. The study highlights gaps in the integration of certain interventions and quality assurance systems.

Abstract

Background 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. Methods 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. Results 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. Conclusions 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.

Key findings

• Not reported in abstract.

Limitations

• Not reported in abstract.

Elsewhere in the Oxytocin corpus