Are national policies and programs for prevention and management of postpartum hemorrhage and preeclampsia adequate? A key informant survey in 37 countries

Smith, Jeffrey M.; Currie, Sheena; Cannon, Tirza; Armbruster, Deborah; Perri, Julia

doi:10.9745/ghsp-d-14-00034

Cited by 39 publications

(54 citation statements)

References 3 publications

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“…The findings of the present study support existing evidence that many countries either do not have national guidelines on PPH or that their guidelines are not sufficiently up‐to‐date . It is vital that countries have up‐to‐date, comprehensive, and evidence‐based national guidelines on emergency obstetric care as evidence shows a direct relationship between guidelines, improved clinical practice, and better maternal outcomes.…”

Section: Discussionsupporting

confidence: 78%

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Clinical guidelines—the challenges and opportunities: What we have learned from the case of misoprostol for postpartum hemorrhage

Morris

Khatun

2018

Intl J Gynecology & Obste

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Objective To establish whether national guidelines for postpartum hemorrhage (PPH) reflect new scientific evidence on misoprostol, and determine the challenges faced in their implementation. Methods A web‐based survey was sent by email to 130 national societies of obstetrics and gynecology (FIGO Member Associations) in 2016. The survey, composed of 18 questions, covered national guidelines on PPH with particular reference to misoprostol, the creation of national guidelines, and challenges to implementation. Results Completed surveys were received from 69 societies, for a 53% response rate. The key findings were that many countries lacked comprehensive, up‐to‐date, evidence‐based national guidelines providing guidance on misoprostol use; recommended regimens were very different in the national guidelines as well as between international and regional guidelines that are most often used as referencing documents; and there are a variety of challenges to implementation of guidelines. Conclusion There is a need, especially in countries with high maternal mortality, to establish mechanisms that ensure the existence of up‐to‐date, comprehensive, evidence‐based guidelines on PPH. This can be difficult given conflicting guidance at the international level. Regional and international societies should prioritize clinical updates and ensure their dissemination and implementation.

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Section: Discussionsupporting

confidence: 78%

“…The findings of the present study support existing evidence that many countries either do not have national guidelines on PPH or that their guidelines are not sufficiently up-to-date. 10 Clinical guidelines must be disseminated in order to affect change;…”

Section: Discussionmentioning

confidence: 99%

Clinical guidelines—the challenges and opportunities: What we have learned from the case of misoprostol for postpartum hemorrhage

Morris

Khatun

2018

Intl J Gynecology & Obste

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“…The potential of misoprostol lies in low‐resource environments where oxytocin use is limited by its requirements for refrigeration and parenteral administration. In such settings, most strategies for PPH management focus on misoprostol prophylaxis . Despite prophylaxis, however, up to 16% of women may experience excessive bleeding postpartum .…”

Section: Introductionmentioning

confidence: 99%

“…In such settings, most strategies for PPH management focus on misoprostol prophylaxis. [6][7][8] Despite prophylaxis, however, up to 16% of women may experience excessive bleeding postpartum. 9 For the one-third of women who deliver without a skilled birth attendant globally, often the only option to treat PPH is referral, 10 with actual transfer frequently hampered by social and logistical barriers.…”

Section: Introductionmentioning

confidence: 99%

Using misoprostol to treat postpartum hemorrhage in home deliveries attended by traditional birth attendants

Abbas

Jehan²,

Diop

et al. 2019

Intl J Gynecology & Obste

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Objective To explore the clinical and programmatic feasibility of using 800 μg of sublingual misoprostol to prevent and treat postpartum hemorrhage (PPH) during home delivery. Methods The present double‐blind randomized controlled trial included women who underwent home deliveries in Chitral district, Khyber Pakhtunkhwa province, Pakistan, after presenting at healthcare facilities during the third trimester of pregnancy between May 28, 2012, and November 27, 2014. Participants were randomized in a 1:1 ratio to receive either 800 μg of misoprostol or placebo sublingually if PPH was diagnosed, having previously received a prophylactic oral dose of 600 μg misoprostol. The primary outcome, hemoglobin decrease of 20 g/L or greater from pre‐ to post‐delivery assessment, was compared on a modified intention‐to‐treat basis. Results There were 49 patients allocated to receive misoprostol and 38 allocated to receive placebo; the incidence of a 20 g/L decrease in hemoglobin was similar between the groups (20/43 [47%] vs 19/33 [58%], respectively; P=0.335). Conclusion There was no significant difference in clinical outcomes between the two trial arms. ClinicalTrials.gov:NCT01485562.

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“…These include MgSO 4 not being registered or licensed for use for pre-eclampsia/eclampsia, lack of centralised purchasing and distribution mechanisms, lack of evidence-based clinical protocols, insufficient training and shortage of staff to safely deliver MgSO 4 and fear of toxicity. [10][11][12][13][14][15] Nonetheless, there is evidence to suggest that limited coverage of MgSO 4 may be related more to local clinical practices than the availability of the medication. For instance, the WHO Multi-Country Survey on Maternal and Newborn Health (WHO MCS) in 2010/11 reported high coverage of MgSO 4 use for eclampsia prevention and treatment in facilities in many low-and middle-income countries; however, it did not appear to be related to lower rates of adverse outcomes due to pre-eclampsia/eclampsia.…”

Section: Introductionmentioning

confidence: 99%

Clinical practice patterns on the use of magnesium sulphate for treatment of pre‐eclampsia and eclampsia: a multi‐country survey

Long

Oladapo

Leathersich

et al. 2016

BJOG

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ObjectiveTo characterise the current clinical practice patterns regarding the use of magnesium sulphate (MgSO 4) for eclampsia prevention and treatment in a multi‐country network of health facilities and compare with international recommendations.DesignCross‐sectional survey.SettingA total of 147 health facilities in 15 countries across Africa, Latin America and Asia.PopulationHeads of obstetric departments or maternity units.MethodsAnonymous online and paper‐based survey conducted in 2015.Main outcome measuresAvailability and use of MgSO 4; availability of a formal clinical protocol for MgSO 4 administration; and MgSO 4 dosing regimens for eclampsia prevention and treatment.ResultsMagnesium sulphate and a formal protocol for its administration were reported to be always available in 87.4% and 86.4% of all facilities, respectively. MgSO 4 was used for the treatment of mild pre‐eclampsia, severe pre‐eclampsia and eclampsia in 24.3%, 93.5% and 96.4% of all facilities, respectively. Regarding the treatment of severe pre‐eclampsia, 26.4% and 7.0% of all facilities reported using dosing regimens that were consistent with Zuspan and Pritchard regimens, respectively. Across regions, intramuscular maintenance regimens were more commonly used in the African region (45.7%) than in the Latin American (3.0%) and Asian (22.9%) regions, whereas intravenous maintenance regimens were more often used in the Latin American (94.0%) and Asian (60.0%) regions than in the African region (21.7%). Similar patterns were found for the treatment of eclampsia across regions.ConclusionsThe reported clinical use of MgSO 4 for eclampsia prevention and treatment varied widely, and was largely inconsistent with current international recommendations.Tweetable abstractMgSO 4 regimens for eclampsia prevention and treatment in many hospitals are inconsistent with international recommendations.

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Are national policies and programs for prevention and management of postpartum hemorrhage and preeclampsia adequate? A key informant survey in 37 countries

Cited by 39 publications

References 3 publications

Clinical guidelines—the challenges and opportunities: What we have learned from the case of misoprostol for postpartum hemorrhage

Clinical guidelines—the challenges and opportunities: What we have learned from the case of misoprostol for postpartum hemorrhage

Using misoprostol to treat postpartum hemorrhage in home deliveries attended by traditional birth attendants

Clinical practice patterns on the use of magnesium sulphate for treatment of pre‐eclampsia and eclampsia: a multi‐country survey

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