Table Of Contents
Why A Standardized Approach To PPH Treatment?
The Great Need For A Standardized Approach
To achieve no PPH deaths or at least significant reduction in maternal deaths, it is important to have vivid guidelines which consider both non-clinical and clinical aspects in the management of PPH. These two aspects must work in tandem or neither of them will work well.
The story of PPH begins with unawareness, unwillingness, nonavailability, untimely approach, unskilled personnel’s and so on and so forth; it ends in severe complications or death.
The Current Guidelines
Royal College of Obstetricians and Gynaecologists (RCOG)
This guideline provides information about the prevention and management of postpartum hemorrhage (PPH), primarily for clinicians working in obstetric-led units in the UK; recommendations may be less appropriate for other settings where facilities, resources and routine practices differ.
World Health Organization (WHO)
One of the Millennium Development Goals set by the United Nations in 2000 was to reduce maternal mortality by three-quarters by 2015. Beyond this, countries need evidence-based guidelines on the safety, quality, and usefulness of the various interventions. These will provide the foundation for the strategic policy and programme development needed to ensure realistic and sustainable implementation of appropriate interventions. PPH is generally defined as blood loss greater than or equal to 500 ml within 24 hours after birth, while severe PPH is blood loss greater than or equal to 1000 ml within 24 hours. PPH is the most common cause of maternal death worldwide. Most cases of morbidity and mortality due to PPH occur in the first 24 hours following delivery and these are regarded as primary PPH whereas any abnormal or excessive bleeding from the birth canal occurring between 24 hours and 12 weeks postnatally is regarded as secondary PPH.
American College Of Obstetricians and Gynecologists (ACOG)
ACOG recommends that all hospitals put organized, systematic processes in place to help coordinate the response and management of postpartum hemorrhage. In an effort to reduce rates of maternal mortality and morbidity nationwide, ACOG partners with 24 organizations to implement the Alliance for Innovation on Maternal Health (AIM), which includes the implementation of consistent maternity care practices for several conditions including obstetric hemorrhage. Today, 13 states and three health networks, representing 1.5 million births, are active participants.
The Next Step In Standards
While the current guidelines provide valuable information and practices, there is still a need for more.
None of the current guidelines discuss the bundle approach to PPH prevention. The bundle approach, which SaveMothers.org supports through donations and community activity, is evidence-based and is "need of the hour". By providing a comprehensive, effective, and cost-efficient solution to PPH, the bundle approach serves as a critical next step to the standards and guidelines already promoted by the esteemed organizations above.
This is why there is a great need for formulating further standardized guidelines with critical attention to the bundle approach solution.