Postpartum hemorrhage in developing countries: is the public health community using the right tools?
OBJECTIVE
To identify new and underutilized technologies that may assist in reducing maternal mortality due to obstetric hemorrhage.


METHODS
Review of published and unpublished literature, including systematic reviews of randomized trials and individual clinical studies.


RESULTS
Hemorrhage, primarily postpartum, accounts for approximately 25% of maternal deaths globally. Uterotonic drugs offer great promise for both prevention and management of postpartum hemorrhage (PPH). Other technologies--such as anti-shock garments, umbilical vein injection of oxytocin, and simple anemia detection methods--represent potential new opportunities to reduce PPH-related mortality.


CONCLUSIONS
Clinical and operational research is needed to answer remaining questions about misoprostol, the anti-shock garment, and umbilical vein injection of oxytocin for retained placenta. Efforts are needed to ensure the availability of technologies with proven value, such as oxytocin in Uniject prefilled injection devices. Equally important, technologies and techniques with proven efficacy--such as active management of third-stage labor and aortic compression--must be translated into general use by disseminating the evidence for them, incorporating them into national guidelines and training curricula, and ensuring the availability of supportive supplies and equipment.
Tsu
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VD
Program for Appropriate Technology in Health, Seattle, WA, USA. vtsu@path.org
Langer
A
A
Aldrich
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T
D003906:Developing Countries; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008427:Maternal Health Services / Q000458:organization & administration*; D008428:Maternal Mortality; D008507:Medically Underserved Area; D010120:Oxytocics / Q000008:administration & dosage; D006473:Postpartum Hemorrhage / Q000517:prevention & control*; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic
D010120:Oxytocics