title: Preventing deaths due to haemorrhage.
abstract: Prevention of deaths from obstetric haemorrhage requires effective health systems including family planning, commodities, personnel, infrastructure and ultimately universal access to comprehensive obstetric care for women giving birth. The main causes of death associated with antepartum haemorrhage are placental abruption, placenta praevia and uterine rupture. Preventive measures include preconceptual folate supplementation, management of hypertensive disorders, early diagnosis of placenta praevia and use of uterine stimulants cautiously, particularly misoprostol. Preventive measures for post-partum haemorrhage include routine active management of the third stage of labour. Treatment involves a cascade of increasingly invasive interventions in rapid sequence until the bleeding is stopped. These interventions include fluid resuscitation, removal of the placenta, bimanual uterine compression, uterotonics, tranexamic acid, suturing of lower genital tract injury, blood product replacement, balloon tamponade, laparotomy, stepwise uterine devascularization, uterine compression sutures and hysterectomy. Emergency temporizing measures include application of the non-pneumatic anti-shock garment, and at laparotomy, aortic compression and uterine tourniquet application. The effectiveness of treatment methods and the optimal dosage of misoprostol are research priorities. Interesting new approaches include transvaginal uterine artery clamping and suction uterine tamponade.
authors.affiliation: Effective Care Research Unit, Universities of the Witwatersrand and Fort Hare and Eastern Cape Department of Health, South Africa; Centre for Evidence-Based Health Care, University of Stellenbosch, South Africa; Frere Maternity Hospital, Amalinda Drive, East London, South Africa. Electronic address: justhof@gmail.com.
authors.forename: G Justus
authors.initials: GJ
authors.lastname: Hofmeyr
authors.affiliation: Department of Obstetrics and Gynaecology, School of Medicine, College of Health Sciences, University of Nairobi, Kenya. Electronic address: zahida@qureshi.co.ke.
authors.forename: Zahida
authors.initials: Z
authors.lastname: Qureshi
mesh_terms: D000037:Abruptio Placentae / Q000628:therapy*; D000933:Antifibrinolytic Agents / Q000627:therapeutic use*; D001803:Blood Transfusion; D002585:Cesarean Section; D000077324:Crystalloid Solutions; D004874:Ergonovine / Q000627:therapeutic use; D005260:Female; D005440:Fluid Therapy; D005676:Gravity Suits; D006268:Health Facilities; D006700:Home Childbirth; D006801:Humans; D007044:Hysterectomy; D007552:Isotonic Solutions / Q000627:therapeutic use; D007751:Labor, Induced; D008405:Massage / Q000379:methods; D063130:Maternal Death / Q000209:etiology / Q000517:prevention & control*; D016595:Misoprostol / Q000627:therapeutic use; D010120:Oxytocics / Q000627:therapeutic use*; D010121:Oxytocin / Q000627:therapeutic use; D010923:Placenta Previa / Q000628:therapy*; D006473:Postpartum Hemorrhage / Q000628:therapy*; D011247:Pregnancy; D014111:Tourniquets; D014148:Tranexamic Acid / Q000627:therapeutic use; D055357:Uterine Artery Embolization / Q000379:methods; D058738:Uterine Balloon Tamponade / Q000379:methods; D014592:Uterine Hemorrhage / Q000150:complications / Q000628:therapy*; D014597:Uterine Rupture / Q000628:therapy*
chemical_list: D000933:Antifibrinolytic Agents; D000077324:Crystalloid Solutions; D007552:Isotonic Solutions; D010120:Oxytocics; D016595:Misoprostol; D010121:Oxytocin; D014148:Tranexamic Acid; D004874:Ergonovine
keywords: active management of the third stage of labour; post-partum haemorrhage; prevention; treatment; uterotonics