MCHIP also strengthened the capacity of skilled birth attendants in provision of AMTSL as part of clean and safe delivery at health facility level. In partnership with the MoH&Social Welfare, MCHIP in Liberiaworked in two districts and 189 villages to build the skills of health workers, including their ability to provide counseling on: birth preparedness and complication readiness referral of pregnant women for antenatal care and counseling and distribution of misoprostol for self-administration by women at the time of birth. The intervention was implemented in two counties of South Sudan: Mundri East and Mvolo. The program strengthened AMTSL and management of PPH at health facilities, combined with counseling and distribution of misoprostol by health care providers and Home Health Promoters (Community Health Workers in South Sudan) for use at home births. This program had two parts-a learning phase, 4 during which the Ministry of Health (MoH) questions of feasibility and program structure were answered and an expansion phase, during which lessons learned in the learning phase were scaled up through MoH, USAID and other development partners. MCHIP worked in 11 African and Asian countries, using misoprostol at homebirths to prevent PPH.ĭue to its high maternal mortality ratio (the highest in the world) and rate of home births, as well as limited access to health care, South Sudan was the first country in which MCHIP rolled out the community distribution of misoprostol for prevention of PPH to help reduce maternal deaths. Using Misoprostol at Homebirths to Prevent PPH Findings conclude that use of skilled providers (and thus AMTSL) increases, and women who do not have access to skilled providers still have the protection against PPH afforded by misoprostol. Several interventions have shown the feasibility of an approach that educates women on the need for a skilled provider at birth, provides counseling on use of and distribution of misoprostol to be used in the event that the birth takes place without a skilled provider, and follows up women after birth. Misoprostol tablets are ideally suited for PPH treatment at home births and in resource-poor settings due to their ease of use, effectiveness and safety. Recent WHO recommendations approve administration of misoprostol by a health worker trained in its use for PPH prevention in the absence of a skilled provider who can perform AMTSL. Use of a uterotonic drug immediately after the delivery of the newborn is one of the most important interventions to prevent PPH.ĪMTSL involves three basic steps: injection of a uterotonic agent (preferably oxytocin) within one minute following the delivery of the baby delivery of the placenta with controlled cord traction and counter-traction to the uterus and massage of the uterus after delivery of the placenta, with palpation of the uterus to assess the need for continued massage for the two hour period following delivery of the placenta. Uterotonics (such as oxytocin and misoprostol) cause uterine contractions and have long been used to treat uterine atony and reduce the amount of blood lost following childbirth. These include the use of active management of third stage of labor (AMTSL) by a skilled provider, or use of misoprostol by women who give birth without a skilled provider. “Secondary” PPH, defined as hemorrhage after the first 24 hours but less than 6 weeks postpartum, can be produced by retained placental fragments and infection.Įvidence-Based Interventions to Prevent PPHĮvidence-based interventions suitable for low-resource settings are available that reduce the incidence of PPH and can be implemented by skilled providers or trained community health workers. Notably, the majority of PPH cases occur in women without these factors and who otherwise have normal pregnancies and labors. Other causes include retained placenta, inverted or ruptured uterus, and cervical, vaginal or perineal lacerations. Factors that can contribute to PPH due to uterine atony are high parity, PPH in a previous delivery, a large fetus, multiple fetuses, or excessive amniotic fluid. However, even a small amount of blood loss can be life-threatening for anemic women-and the great majority of women in the developing world are anemic. Postpartum Hemorrhage (PPH) is excessive vaginal bleeding of greater than 500 ml after childbirth. Cervical Cancer Prevention for Women Living with HIV.Prevention of Mother-to-Child Transmission of HIV.Infant and Young Child Nutrition to Prevent Stunting.Preventing and Treating Diarrheal Disease.Interventions for Pre-Eclampsia/Eclampsia.
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