Postpartum hemorrhage - vouch.

Color profile: Generic CMYK printer profileComposite Default screen ‘With the emerging evidence on the use of various routes of administration of misoprostol,particularly in the non-hospital setting, it is becoming clear that this drug should be available atthe community level in the hands of trained personnel, especially where oxytocin, Uniject and otheruterotonics are not present or practical for use.’ The Working Group of the Goa International Conference on the Prevention of Post Partum Hemorrhage, July 15, 2006, Goa, India Prior to the availability of misoprostol, it was impossible to carry any significant element of tionary at first glance, they should be viewed as emergency obstetric care into homes where an essential step towards a long-term strategy women deliver without a skilled birth attendant.
where all women can be delivered by a certified As a low-cost, easy-to-administer, powerful midwife or physician practicing active manage- uterotonic with an excellent safety profile and ment of the third stage of labor. Over the past long shelf-life, misoprostol has a revolutionary half-century, countries such as Sri Lanka and potential to reduce death and morbidity from Thailand have brought maternal mortality to postpartum hemorrhage in precisely those situa- low levels by ensuring over 90% of deliveries are tions where it is most common – delivery at attended by a skilled person able to use an home without a skilled birth attendant.
oxytocic, and ultimately all countries should trial in India, administration of 600 µg miso- prostol orally immediately after delivery sig- nificantly reduced postpartum hemorrhage (see AIDS in some African countries and the endless Addendum). Research in Indonesia, Nepal and recruitment of skilled health professions from elsewhere is showing that community volun- developing to developed countries will make the teers with minimal training can teach illiterate road to providing comprehensive obstetric care women to self-administer misoprostol effectively long and slow. During this interval, widespread and responsibly1 (see Chapter 19). A 1000 µg access to misoprostol and the education to use it rectal dose of misoprostol can be used to treat safely during home births have the potential to postpartum hemorrhage, in situations where an make a significant contribution – perhaps even appropriate technology exists to diagnose blood the single most important contribution – to loss (such as blood-soaked sarong or ‘kanga’), reducing the global burden of deaths from and where births are attended by traditional postpartum hemorrhage. The only other practi- birth attendants (TBAs). In Tanzania, illiterate cal intervention with the potential to reduce TBAs, with a brief training, used misoprostol to postpartum hemorrhage in low-resource set- bring about a highly significant reduction in the tings is realistic access to family planning, as all number of women who needed to be referred to women who wish to limit childbearing are at risk hospital or receive intravenous treatment2.
Z:\Sapiens Publishing\A5211 - Postpartum Hemorrhage\Make-up\Postpartum Hemorrhage - Voucher Proofs #T.vp06 September 2006 14:27:54 Color profile: Generic CMYK printer profileComposite Default screen higher-parity women, who have the greatest unmet need for family planning, are at even project of community-based distribution of miso- prostol for prevention of PPH in rural Indonesia.
Proceedings of Preventing Postpartum Hemorrhage:From Research to Practice, Bangkok, Thailand, References
2. Prata N, Mbaruka G, Campbell M, Potts M, 1. Wiknjosastro G, Sanghvi H. Preventing PPH Vahidnia F. Controlling postpartum hemorrhage after home births in Tanzania. Int J Gynaecol proportion of births are not attended by skilled providers: Safety, acceptability, feasibility and Editors’ Addendum
The Editors wish to bring the reader’s atten- R. J. Derman1, B. S. Kodkany2, S. S.
tion to the paper referred to by Professor Goudar2, S. E. Geller3, V. A. Naik2, M. B.
Potts on page 156. This paper has been pub- lished in the October 7, 2006 issue of The Edlavitch1, T. Hartwell5, H. Chakraborty5, Lancet. To the Editors’ knowledge, this is the N. Moss6. Oral misoprostol in preventing post- largest placebo-controlled study of miso- partum hemorrhage in a community setting.
1University of Missouri-Kansas City School misoprostol significantly reduced the rate of College, Belgaum, Karnataka, India; 3Univer- postpartum hemorrhage in the patients who sity of Illinois, Chicago College of Medicine, were administered this agent in comparison to USA; 4John H. Stroger Jr. Hospital of Cook the patients who received the placebo control.
County, USA; 5Statistics and Epidemiology, The full title of the paper and all authors RTI International; 6National Institute of Z:\Sapiens Publishing\A5211 - Postpartum Hemorrhage\Make-up\Postpartum Hemorrhage - Voucher Proofs #T.vp04 September 2006 13:53:27


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