Rethinking our approach to postpartum haemorrhage and uterotonics

Weeks, Andrew ORCID: 0000-0002-1909-337X and Neilson, James (2015) Rethinking our approach to postpartum haemorrhage and uterotonics. BMJ, 351. h3251-.

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Abstract

Analysis Rethinking our approach to postpartum haemorrhage and uterotonics BMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h3251 (Published 08 July 2015) Cite this as: BMJ 2015;351:h3251 Article Related content Metrics Responses Peer review Andrew D Weeks, professor of international maternal health1, James P Neilson, professor of obstetrics and gynaecology1 Author affiliations Correspondence to: AD Weeks aweeks@liv.ac.uk Accepted 30 March 2015 Andrew Weeks and James Neilson suggest that we have inappropriately generalised evidence on the use of uterotonics from uncomplicated births to all births. They call for stronger focus on women with complex births to reduce deaths from postpartum haemorrhage Postpartum haemorrhage (defined as a bleed >500 mL) is estimated to affect 1-15% of vaginal births, depending on the definition used, the method of assessing blood loss, the setting, and the population studied. Risk factors include Asian ethnicity, obesity, previous postpartum haemorrhage, multiple pregnancy, anaemia, large baby, age over 40, induction of labour, prolonged labour, placental abruption, and caesarean delivery.1 Although global mortality from postpartum haemorrhage is falling, its incidence is increasing in high resource settings, the reasons for which are unclear.2 3 4 Many of those who survive have severe anaemia, renal failure, or psychological trauma, and the offspring may have difficulties in breast feeding and bonding. Current best practice globally is for all pregnant women to receive a uterotonic drug at the time of childbirth to prevent postpartum haemorrhage. This recommendation has been in place since the 1980s when randomised trials showed that routine prophylaxis with oxytocin based uterotonic drugs reduced the rate of postpartum haemorrhage.5 The assumption that this would translate into fewer maternal deaths—based on the understanding that atony was the most common cause of haemorrhage related deaths—led to the promotion of active management of the third stage of labour, which comprises a prophylactic uterotonic drug, early cord clamping, and controlled cord traction. Here we discuss the problems with generalising data from spontaneous vaginal (“normal”) births to complex births, and call for a change in global strategy on postpartum haemorrhage.

Item Type:	Article
Additional Information:	First published in BMJ 2015;351:h3251 doi: 10.1136/bmj.h3251
Uncontrolled Keywords:	Developing Countries, Evidence-Based Medicine, Female, Health Resources, Humans, Labor Stage, Third, drug effects, Oxytocics, administration & dosage, adverse effects, Postpartum Hemorrhage, drug therapy, prevention & control, Practice Guidelines as Topic, Pregnancy, Randomized Controlled Trials as Topic, Risk Factors
Subjects:	?? RG ??
Depositing User:	Symplectic Admin
Date Deposited:	22 Jan 2016 17:10
Last Modified:	15 Dec 2022 11:52
DOI:	10.1136/bmj.h3251
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/2047825