RESUMEN
Postpartum haemorrhage is the leading cause of preventable maternal mortality in South Africa. In a significant breakthrough in the management of PPH, the E-MOTIVE trial found that a multifaceted health service intervention reduced severe PPH after vaginal delivery by 60% in 78 hospitals in Nigeria, Kenya, Tanzania and SA. The E-MOTIVE approach comprises objective blood loss measurement monitored every 15 minutes during the first hour after delivery to detect PPH early and trigger a bundle of first-line treatments, including massaging the uterus, oxytocin infusion, tranexamic acid infusion, intravenous crystalloid fluids, examination for the cause, emptying the bladder and, if necessary, escalation of care. E-MOTIVE was integrated into the existing Essential Steps in Managing Obstetric Emergencies algorithm. Certain research-related elements of the trial setting cannot be replicated in routine practice. Therefore, we need to develop local strategies to ensure the essential clinical elements of the intervention are implemented. Potential strategies include incorporating the E-MOTIVE principles into national guidelines, ongoing training strategies and ensuring all facilities are equipped with necessary medication, equipment and delegations. This breakthrough intervention provides hope for women in SA, and requires a purposeful, co-ordinated implementation strategy on a national scale to reach all levels of the health service.
Asunto(s)
Oxitócicos , Hemorragia Posparto , Femenino , Humanos , Embarazo , Parto Obstétrico , Oxitócicos/uso terapéutico , Oxitocina/uso terapéutico , Hemorragia Posparto/diagnóstico , Hemorragia Posparto/terapia , Sudáfrica , Ensayos Clínicos como AsuntoRESUMEN
The second stage of labor, from full cervical dilatation to complete birth of the baby or babies, constitutes the time of greatest risk for the baby. Birth attendants at all levels require training in the skills necessary to overcome difficulties that may arise unexpectedly during the second stage, particularly poor progress, shoulder dystocia, and breech birth. The mother should receive emotional support and encouragement to bear down instinctively when she feels the urge to do so, in the position she feels enables her to push most effectively, but not the supine position. The baby's heart rate should be monitored after every second contraction. Recent guidelines such as those of the World Health Organization(WHO) recommend allowing 2-3 h for the second stage of labor. Uterine fundal pressure has not been shown to be effective, and may be dangerous. Choosing between cesarean section and assisted vaginal birth to overcome delayed second stage requires relevant skill and experience.
Asunto(s)
Cesárea , Distocia , Frecuencia Cardíaca Fetal/fisiología , Segundo Periodo del Trabajo de Parto/fisiología , Distocia/prevención & control , Femenino , Humanos , Parto , EmbarazoRESUMEN
Uterine balloon tamponade (UBT) is widely used to treat postpartum haemorrhage (PPH). Randomised trials of UBT are scarce: those of improvised condom UBT in low-resource settings found more harm than good. Uterine suction tamponade (UST) is more aligned with the physiological mechanism of uterine haemostasis (contraction), but purpose-designed devices may be unaffordable or unavailable when needed. We describe a technique of UST using an inexpensive Levin suction catheter. Use of the described technique as a last resort in three cases of life-threatening PPH resulted in prompt cessation of bleeding. We emphasise the need for randomised trials to confirm effectiveness.