Strategy for Zero Maternal Deaths by Hemorrhage in Brazil: A Multidisciplinary Initiative to Combat Maternal Morbimortality

Osanan, Gabriel Costa; Padilla, Haydee; Reis, Monica; Tavares, Adriano Bueno

doi:10.1055/s-0038-1639587

Cited by 14 publications

(12 citation statements)

References 3 publications

(2 reference statements)

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“…Worldwide and in Latin America and the Caribbean (including Suriname), PPH was the most frequent direct underlying cause of maternal deaths in 2010 [1,17]. To reduce preventable maternal mortality from PPH in the Americas The Pan-American Health Organization (PAHO) and its Latin American Center for Perinatology, Women and Reproductive Health launched the "Zero Maternal Mortality from Hemorrhage" initiative in 2015 [24]. Following the designation of Suriname as one of 10 priority countries for reducing maternal mortality, PAHO implemented this project in Suriname in 2018 [25].…”

Section: Plos Onementioning

confidence: 99%

Postpartum hemorrhage in Suriname: A national descriptive study of hospital births and an audit of case management

et al. 2020

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Background Postpartum hemorrhage (PPH) is the leading cause of direct maternal mortality globally and in Suriname. We aimed to study the prevalence, risk indicators, causes, and management of PPH to identify opportunities for PPH reduction. Methods A nationwide retrospective descriptive study of all hospital deliveries in Suriname in 2017 was performed. Logistic regression analysis was applied to identify risk indicators for PPH (≥ 500ml blood loss). Management of severe PPH (blood loss ≥1,000ml or ≥500ml with hypotension or at least three transfusions) was evaluated via a criteria-based audit using the national guideline. Results In 2017, the prevalence of PPH and severe PPH in Suriname was 9.2% (n = 808/8,747) and 2.5% (n = 220/8,747), respectively. PPH varied from 5.8% to 15.8% across the hospitals. Risk indicators associated with severe PPH included being of African descent (Maroon aOR 2.1[95%CI 1.3–3.3], Creole aOR 1.8[95%CI 1.1–3.0]), multiple pregnancy (aOR 3.4[95%CI 1.7–7.1]), delivery in Hospital D (aOR 2.4[95%CI 1.7–3.4]), cesarean section (aOR 3.9[95%CI 2.9–5.3]), stillbirth (aOR 6.4 [95%CI 3.4–12.2]), preterm birth (aOR 2.1[95%CI 1.3–3.2]), and macrosomia (aOR 2.8 [95%CI 1.5–5.0]). Uterine atony (56.7%, n = 102/180[missing 40]) and retained placenta (19.4%, n = 35/180[missing 40]), were the main causes of severe PPH. A criteria-based audit revealed that women with severe PPH received prophylactic oxytocin in 61.3% (n = 95/155[missing 65]), oxytocin treatment in 68.8% (n = 106/154[missing 66]), and tranexamic acid in 4.9% (n = 5/103[missing 117]). Conclusions PPH prevalence and risk indicators in Suriname were similar to international and regional reports. Inconsistent blood loss measurement, varied maternal and perinatal characteristics, and variable guideline adherence contributed to interhospital prevalence variation. PPH reduction in Suriname can be achieved through prevention by practicing active management of the third stage of labor in every birth and considering risk factors, early recognition by objective and consistent blood loss measurement, and prompt treatment by adequate administration of oxytocin and tranexamic acid according to national guidelines.

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Section: Plos Onementioning

confidence: 99%

Postpartum hemorrhage in Suriname: A national descriptive study of hospital births and an audit of case management

et al. 2020

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“…(2) Most of these deaths are considered preventable and occur in low-and middle-income countries. (3) In addition to high mortality, a significant number of patients who survive severe PPH evolve with physical and/or emotional sequelae. (4) Therefore, it is essential that all institutions and professionals that provide childbirth care are properly prepared to prevent, diagnose and manage a condition of PPH.…”

Section: Clinical Contextmentioning

confidence: 99%

“…Fibrinogen must be measured and, when available, viscoelastic tests may contribute to reduce the use of blood components. Therapeutic targets are Hb> 8 g/dL, fibrinogen between 150 and 200 mg/dL, platelets> 50,000/mm 3 and INR ≤ 1.5. (6,34)…”

Section: When and How To Use An Intrauterine Balloon Tamponade?mentioning

confidence: 99%

Postpartum hemorrhage: prevention, diagnosis and non-surgical management

Alves

Francisco

Osanan

et al. 2020

Rev Bras Ginecol Obstet

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“…In this scenario, the acceleration of maternal mortality reduction has been established as one of the global priority targets in the United Nations Sustainable Development Goals. 1 Avoidable maternal mortality and related to the quality in obstetric care persists as a severe public health problem. Such deaths are not randomly distributed among women and reveal inequity of the population in which they occur, since they are concentrated in developing countries, mainly affecting black women with lower income and lower schooling levels.…”

Section: Introductionmentioning

confidence: 99%

Avoidable maternal mortality as social injustice

Júnior

2020

Rev. Bras. Saude Mater. Infant.

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Safe motherhood is not a reality for many women and maternal mortality persists as a severe public health problem. This paper aims to discuss avoidable maternal mortality beyond health issues emphasising on human rights violations and the multiple social repercussions on this complex phenomenon. From the human rights perspectives, avoidable maternal death can be characterized as violation of rights related to life, freedom and the person’s safety, family life, equality and non-discrimination, as well as to the highest attainable standard of health and benefits from scientific progress. When reproductive health risks are faced by pregnant women, they are not restricted to inherent issues such as pregnancy but they reflecton issues strongly linked in the need of gender equality and empowerment for all women and girls, and avoidable maternal mortality should be understood by everyone as a serious injustice tha tdiscriminates women and violates their fundamental rights. The avoidable maternal death recharacterisation, beginning from health disadvantage to social injustice, should develop a collective critical awareness involving the population, giving visibility repercussions for the individual, the family and the population, as well as promoting new interdisciplinary possibilities in coping, sharing and focusing on social control in public policies.

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Strategy for Zero Maternal Deaths by Hemorrhage in Brazil: A Multidisciplinary Initiative to Combat Maternal Morbimortality

Cited by 14 publications

References 3 publications

Postpartum hemorrhage in Suriname: A national descriptive study of hospital births and an audit of case management

Postpartum hemorrhage in Suriname: A national descriptive study of hospital births and an audit of case management

Postpartum hemorrhage: prevention, diagnosis and non-surgical management

Avoidable maternal mortality as social injustice

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