WHO guidelines for the management of postpartum haemorrhage ...

WHO guidelines for the management of postpartum haemorrhage and retained placenta
Clarification of the role of tranexamic acid in PPH and obstetric haemorrhage was
identified as a priority. Some clinicians in the Consultation mentioned that they
already use tranexamic acid, while others did not. There seems to be uncertainty
among clinicians and an absence of evidence. The Consultation was informed that a
large multicentre trial is planned.
(b) Procedures
Uterine massage is recommended for routine care of women in the immediate
postnatal period up to two hours. However, it has not been evaluated as a
therapeutic option in a clearly defined way. Since this is a simple intervention that
can even be self-administered, the Consultation considered that evaluating strategies
to train health workers and mothers in the use of uterine massage would be worth
while.
Balloon or condom tamponade for the treatment of PPH is highly valued by some
practitioners, but not used at all by others. The Consultation considered that this
intervention can be highly effective, but may also have potential complications; it
should be rigorously evaluated as a priority.
The Consultation noted the lack of evidence regarding the role of antibiotics
following manual extraction of a retained placenta. In settings where antibiotics are
not currently routinely administered, it may be worth while to evaluate the benefits
and harms.
(c) Training programmes
The Consultation noted that there was no primary evidence on the effectiveness of
training programmes in obstetric haemorrhage and agreed that evaluations of such
programmes should be a priority, since they require financial and human resources.
(d) Implementation research
The Consultation noted that some strategies for implementation of guidelines have
been shown to be effective. However, there may be a need for new primary research
projects in different contexts to study the implementation of these particular
recommendations.
Plans for local adaptation of the
recommendations
The WHO Department of Reproductive Health and Research works with international
partners, including its collaborating centres and WHO country and regional offices, to
promote the dissemination and adaptation of its recommendations. Specifically, the
Department has been collaborating with the United Nations Population Fund (UNFPA)
since 2004 in a Strategic Partnership Programme to support country-level adaptation
and implementation of sexual and reproductive health guidelines. The Department
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