Prevention of Postpartum Hemorrhage Initiative - Toolkit

Part of a website that provides a forum for joint information sharing and learning between organisations and individuals working on the prevention and treatment of postpartum hemorrhage (PPH) in developing countries, this toolkit is designed to "respond to the urgent need to make real progress in reducing maternal mortality globally".

The Prevention of Postpartum Hemorrhage Initiative toolkit provides information and materials for: (i) health care providers, so they can prevent PPH through active management of the third stage of labour (AMTSL) and manage the most common causes of PPH; (ii) health management teams and health facility managers, so they can ensure that all of the necessary supplies and equipment are available to practice AMTSL; and (iii) policymakers, so they can advocate for necessary policy change to assure that active management of the third stage of labour is available to all women giving birth. The website contains resources posted under the Prevention of Postpartum Hemorrhage Initiative (POPPHI) and includes information and links to a range of organisations working on PPH issues.

The toolkit is comprised of 6 sections:

1. A section including World Health Organization (WHO), International Federation of Gynecology and Obstetrics (FIGO), and International Confederation of Midwives (ICM) statements/recommendations for prevention of PPH and support for AMTSL.
2. A section providing a summary of research and copies of articles published in peer-reviewed journals that provide an evidence base for active management of the third stage of labour to: support offering AMTSL to every woman at every vaginal birth; promote oxytocin as the uterotonic of choice for AMTSL when injectable uterotonic drugs are available; support use of misoprostol for the prevention and treatment of PPH; practice controlled cord traction to facilitate expulsion of the placenta; and delay cord clamping for 2-3 minutes after birth of the baby.
3. A section providing a set of tools to assist country programmes to scale up AMTSL by identifying areas that need to be strengthened in terms of: policy and practice, in- and pre-service education, uterotonic drugs and logistics, and monitoring and evaluation. This section also addresses selection of: (i) facility- and community-based interventions to prevent PPH, and (ii) interventions for scaling up AMTSL activities at the community and facility levels.
4. A section focusing on clinical care and guidelines for prevention and treatment of PPH that provides: a step-by-step description of AMTSL, a brief overview of comprehensive interventions to prevent PPH, WHO guidelines for management of the most common causes of PPH, and updates on new advances for treatment of PPH in low-resource settings.
5. A section containing reference articles on the research that has been conducted regarding the advantages and disadvantages of the various drugs that may be used for active management of the third stage of labour. Amongst the resources: an update on oxytocin in Uniject and use of time-temperature-indicators (TTI) for ensuring potency of oxytocin. There are also items such as fact sheets on uterotonic drugs.
6. A section providing PowerPoint slide presentations on topics such as: promotion of evidence-based care, evidence for active management of the third stage of labour, steps of AMTSL, selection of uterotonic drugs for AMTSL, and pathways to national scale-up of AMTSL.