Postpartum haemorrhage (PPH) is the largest direct cause of maternal mortality. Significant research over the last decade has led to new World Health Organization (WHO) recommendations on the use of Tranexamic Acid (TXA) for the treatment of PPH (2017) and on the use of uterotonics for the prevention of PPH (2018). In 2021, the International Federation of Gynecology and Obstetrics (FIGO) and the International Confederation of Midwives (ICM) also published two joint statements of recommendation for the prevention and treatment of postpartum haemorrhage (PPH).
Yet, while critical to quality care, global guidance is often slow to be translated into policy and practice at country level due to limited access to medicines and technical support. To ensure a tangible impact on PPH prevention and treatment, these new recommendations must reach policy makers, practitioners, and supply chain experts.
FIGO’s Improve Access to essential medicines to reduce PPH morbidity and mortality Project (IAP) (2021 – 2022), in partnership with ICM, has been working with national obstetrics and gynaecology societies and midwives’ associations to update protocols and guidelines for PPH prevention and treatment, and to develop a series of job aids for health facility-based maternal care providers.
FIGO and ICM have developed a generic PPH protocol and clinical pathway tool, based on World Health Organization PPH recommendations, to inform a systematic approach towards the development of policy for PPH management in health facilities. The protocol, now available online in English and French, provides examples of key definitions, early identification of risk, estimation of blood loss, choice of uterotonics, prevention and treatment at various levels of care, effective multidisciplinary teamwork, communication, and referral.
FIGO and ICM have supported Expert Working Groups (EWGs) in Burkina Faso, Ethiopia, Liberia, Ghana, Rwanda, South Sudan, and Uganda to hold a series of virtual workshops aiming to raise awareness of global recommendations, discuss existing national guidelines, and adapt and disseminate the FIGO generic PPH protocol to meet context-specific needs. Each EWG is also supported by the international coordination team to use the generic protocol to develop, design, and disseminate specific job aids for maternity care providers.
The design of the meetings and workshops ensured engagement and ownership of key maternal health stakeholders involved with policy development, education, and clinical practice … combined with focused health system interventions (procurement and supply of quality uterotonics etc.), it is anticipated that the IAP project interventions will contribute to prevention of PPH morbidity and mortality.
– Dr Charles Anawo Ameh, Technical Lead FIGO IAP and Florence West, ICM Midwife Advisor
It is hoped that the FIGO generic PPH protocol will enable professional societies and associations in other countries to use a similarly multidisciplinary collaborative approach to adapt the protocol to specific contexts and to develop effective job aids that will support maternity care providers to prevent and treat PPH.