By Haruna Gimba
The Community Health and Research Initiative (CHR) has applauded the
World Health Organization (WHO) for updating the guidance to prevent
Postpartum Hemorrhage, PPH (excessive bleeding after child birth).
The update of the guidance came after two Guidelines Development Group
(GDG) meetings which led to four main recommendations and six
sub-recommendations on the use of uterotonics for PPH prevention.
According to an article published on the WHO website, every year about
14 million women around the world suffer from postpartum haemorrhage.
This severe bleeding after birth is the largest direct cause of
maternal deaths. In addition to the suffering and loss of women’s
lives, when women die in childbirth, their babies also face a much
greater risk of dying within one month compared to babies whose
mothers survive.
The Executive Director of CHR, Salisu Muhammad Musa described it as a
good development for improving quality maternal health drugs,
“especially for Africa and Nigeria where maternal death through PPH is
very high.”
“While we welcome this new guidance, we therefore call on the Nigerian
government to invest in these drugs as it will go a long way in
preventing PPH in the country.
“Shockingly, 99 per cent of the deaths from PPH occur in low- and
middle-income countries compared with only 1% in high-income countries
although recent studies are showing that it is increasingly an issue
of concern for wealthier countries too. It is hoped that with these
new guidelines, healthcare workers globally will be able to stop women
and their babies from facing unnecessary risks to their health and
lives, wherever they live,” Musa said.
The newly updated recommendations aim to improve the quality of care
and health outcomes for women giving birth. The first recommendation
is related to the efficacy and safety of uterotonics for the
prevention of PPH, and it includes six sub-recommendations. The other
three recommendations are related to the choice of uterotonics for PPH
prevention.
According to the CHR, the new recommendations said that any of the
uterotonics like the oxytocin; carbetocin,
ergometrine/methylergometrine, oxytocin and ergometrine fixed-dose
combination and misoprostol, can be used for the prevention of PPH.
Also in settings where multiple uterotonic options are available,
oxytocin (10 IU, IM/IV) is the recommended uterotonic agent for the
prevention of PPH for all births.
“However in settings where oxytocin is not available, or its quality
cannot be guaranteed, the use of carbetocin, or if appropriate
ergometrine/methylergometrine, or oxytocin and ergometrine fixed-dose
combination, or oral misoprostol is recommended.
“Where the quality of oxytocin is considered compromised due to
inadequate cold-chain transport and storage conditions, heat-sensitive
uterotonic agents such as ergometrine/methylergometrine or oxytocin
and ergometrine fixed-dose combination, that have been transported and
stored under similar conditions as the oxytocin, are not suitable
options. In these situations, heat-stable uterotonic agents
(carbetocin or misoprostol) are suitable options depending on the
context.”
The statement from the CHR added that all the uterotonics recommended
for postpartum haemorrhage prevention, can be used in women undergoing
vaginal birth or caesarean section, and require, except for
misoprostol, a skilled health personnel trained to administer
injectable uterotonics.
“In line with the above, CHR believes that this is a truly encouraging
new development that can revolutionize the ability to keep mothers and
babies alive, especially in the developing and African countries where
stable electricity to preserve these drugs is inadequate.
We therefore called on President MuhammaduBuhari and the 36 States
Governors to invest a certain percentage of the annual health budget
for the procurement, storage and distribution of drugs that will
prevent postpartum hemorrhage, including carbetocin which is heat
stable, to save the lives of mothers and babies,” the statement added.
