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The FIGO Generic Postpartum Haemorrhage Protocol and Care Pathways is now available online

Posted on by Mona

Download the English version here: FIGO Generic Postpartum Haemorrhage Protocol and Care Pathways (EN)

Download the French version here: Parcours de soins et protocole clinique FIGO pour l’hémorragie du postpartum (FR)

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.

FIGO and ICM launch joint statements of recommendation for the prevention and treatment of PPH

Posted on by Mona

The International Federation of Gynecology and Obstetrics (FIGO) and the International Confederation of Midwives (ICM) are pleased to announce the publication of two joint statements of recommendation for the prevention and treatment of postpartum haemorrhage (PPH).

Carlos-PPH-quote

The Joint statement of recommendation for the use of uterotonics for the prevention of postpartum haemorrhage and the Joint statement of recommendation for the use of tranexamic acid for the treatment of postpartum haemorrhage are the culmination of strong and effective collaboration between FIGO and ICM – two of the world’s leading organisations representing specialists in midwifery, obstetrics and gynaecology.

PPH remains the leading cause of maternal mortality in low-income countries and the primary cause of nearly one quarter of maternal deaths globally. The vast majority of these deaths occur in lower-middle-income countries (LMICs) and are a result of a lack of accessible, skilled medical personnel equipped with appropriate supplies, medications and training.

In publishing these joint statements, FIGO and ICM once again illustrate their commitment to effecting positive change in the health and care of women, girls and their families. FIGO President, Dr Carlos Füchtner, highlighted the importance of the recommendations and of working in collaboration and partnership.

”FIGO is proud to be working with and through our national societies, and in collaboration with ICM and national midwife associations. Together, we have developed recommendations on the treatment and management of PPH that can enhance frontline practice, strengthen the provision of care, and ultimately improve the quality of health care services for women and girls around the world – in particular in LMICs”.

ICM President, Franka Cadée, echoed Dr Füchtner’s words, drawing attention to the importance of evidence and putting women, girls and newborns at the centre of their care.

”Respectful collaboration between FIGO and ICM will contribute to a better understanding and appreciation of the complementary and equally significant roles of midwives and obstetricians within the context of preventing and managing PPH.

Operating from an evidence-based standpoint, we encourage members of both professions to leverage these guidelines in an effort to ensure medical interventions during childbirth are appropriately responsive to the context. Underpinning this collaboration and resulting recommendations is the importance of ensuring every woman has the information she needs to make informed decisions about her care, and the care of her newborn”.

For these recommendations to have maximum impact on the prevention and treatment of PPH, policy makers, practitioners and supply chain experts need to be updated on the new recommendations and have access to quality uterotonics and tranexamic acid. Speaking about the implementation of the guidelines, Dr Alison Wright, member of FIGO’s Safe Motherhood and Newborn Health Committee and PPH Working Group, said,

”I am delighted that FIGO and ICM have come together with one voice, to give clear recommendations for the prevention and treatment of PPH. As obstetricians, we look forward to working together with our midwifery colleagues to support implementation of these recommendations at a local level.

Ensuring frontline obstetricians and midwives are appropriately trained and have direct and timely access to effective uterotonics and tranexamic acid will save hundreds of thousands of lives and significantly improve the provision of safe, personalised care for all women, girls and their families worldwide”.

FIGO is proud to be heading up a project to continue the effort for the next phase – to close the gap between global evidence-based recommendations on, and the implementation of, lifesaving medicines.

With our partners ICM, Concept Foundation and MSD for Mothers through the Improving access to essential medicines to reduce postpartum haemorrhage (PPH) morbidity and mortality (IAP) project, FIGO is working to improve the adoption of these recommendations to ensure health care providers are empowered in implementing these interventions at the frontline of the health care system.

Read and download the statements, and find out more about FIGO’s IAP project, using the links above. The statements can also be found in the resource section of this website. 

Statement on uterine balloon tamponade in Postpartum hemorrhage (PPH)

Posted on by Jimmy Madden

Postpartum haemorrhage (PPH) remains the most common cause of maternal death worldwide. Uterine balloon tamponade (UBT) is a simple, inexpensive and readily available method used to treat this.

Suarez et al [1] carried out a systematic review and meta-analysis in January 2020, in which the authors analysed all ninety one eligible studies and found the highest success rates corresponded to uterine atony (87.1%), as opposed to morbidly adherent placental disease, or retained products (66.7 and 76.8% respectively). The frequency of complications attributed to UBT use was low (≤6.5%).

There are conflicting data, with some experimental studies suggesting no beneficial effect, but overall, the authors conclude that UBT has a high success rate for treating PPH and appears to be safe; also acknowledging that further research is needed to determine the most effective programmatic and health care delivery strategies on the introduction and use of UBT.

These findings were corroborated in a study by Adegoke et al, which looked at the use of UBT in Tanzania [2]. This study concluded that ease of use and the prospect of saving life and preserving fertility strongly promoted its use, whilst fear and lack of high-level buy-in hindered utilisation of the UBT.

While these data are not entirely consistent, UBT does appear to be a safe and effective way to reduce PPH, especially in the atonic uterus, which is the most common cause of PPH.
We welcome further work to add to these data, and to further explore how to effectively introduce UBT as part of a care bundle, in our collective efforts to tackle PPH, the leading cause of maternal death globally.

1. Suarez, S., et al., Uterine balloon tamponade for the treatment of postpartum hemorrhage: a systematic review and meta-analysis. Am J Obstet Gynecol, 2020.

2. Adegoke, O., et al., A condom uterine balloon device among referral facilities in Dar Es Salaam: an assessment of perceptions, barriers and facilitators one year after implementation. BMC Pregnancy Childbirth, 2020. 20(1): p. 34.