Postpartum hemorrhage (PPH), the leading cause of maternal death worldwide, claims an estimated 43,000 lives annually and affects approximately 27 million women each year. A comprehensive three-part series published in The Lancet aims to characterize this crisis and propose actionable solutions.
Early Detection and Rapid Intervention
The research highlights the critical need for prompt recognition and treatment of excessive bleeding after childbirth, a condition that can rapidly become life-threatening. “It can become a medical emergency very quickly,” stated Adam Devall, a professor of maternal health at the University of Oxford. “A woman who has had an otherwise uncomplicated labor can deteriorate within minutes if the bleeding is not recognized and treated promptly.” Ioannis Gallos, with the World Health Organization’s Maternal and Perinatal Health Unit, noted that women often sense the severity, saying, “Typically, the women say, ‘I feel like I’m dying.'” He added, “If no one was to act on it, within 10 to 20 minutes, easily a woman can die.” This urgency leads to PPH being described as “a race against time.”
A key recommendation is to move beyond visual estimation of blood loss, which can be inaccurate. Researchers suggest using a specially designed plastic drape placed beneath the woman during childbirth. This drape collects blood and features calibrated lines, allowing healthcare providers to easily measure the volume lost. “These lines allow midwives and doctors to easily see the amount of blood loss after the birth,” explained Devall.
The series advocates for a combination of interventions, including uterine massage to promote contractions, medication, and intravenous fluids, to be administered simultaneously and promptly once a hemorrhage is detected. A large trial conducted in Nigeria, Kenya, Tanzania, and South Africa involving over 200,000 women tested this approach of early detection with a drape, clear treatment criteria, and simultaneous interventions. “We saw a massive decrease in severe bleeding,” reported Devall.
Addressing the Global Survival Gap
The research underscores a significant disparity in survival rates between high-income and lower-resource countries. While the incidence of PPH is similar across different economic settings, the availability and administration of care differ dramatically. Dr. Olufemi Oladapo, a physician with the WHO’s Special Programme on Human Reproduction and a co-author of the series, noted, “The rate of postpartum hemorrhage is not any different between high-income countries and low-income countries. What is different is what is given when these conditions are identified.”
The mortality rate from PPH can be over 200 times higher in under-resourced nations compared to well-resourced ones. Challenges in lower-resource settings include the need for refrigeration for essential drugs like oxytocin, which can help stem bleeding. The series also calls for simulation-based training for entire care teams, akin to pit-stop crews in racing, to improve coordinated responses.
Economic Rationale and Future Outlook
Experts believe that implementing these recommendations can significantly reduce maternal deaths. “Women should not be dying from PPH in this day and age, given what we know,” said Dr. Oladapo. “If we use what we have now, we will reduce more than 95% of the deaths.” The economic argument also favors prevention, with research indicating that PPH currently costs more than preventing it. “If you invest even 5% of the cost of postpartum hemorrhage in preventing it, you’re going to not just save lives but also save money,” Dr. Oladapo concluded.
Dr. Harshad Sanghvi, former Chief Medical Officer at Jhpiego, described the series as a “significant call to action” and expressed optimism that the goal of eliminating PPH as a leading cause of maternal death is achievable within this decade.
Norman Pearlstine is the Chief Editor of News Raise and focuses on Business news. His responsibility is to oversee the editorial content including business, commodities, personal investments and the stock market.
