Postpartum hemorrhage (PPH), defined by the World Health Organization (WHO) as blood loss of 500 ml or more within 24 hours after childbirth, remains a leading cause of maternal mortality globally, including India. However, there is hope. The sooner PPH is identified and diagnosed with an accurate blood loss assessment, the more promptly a bundle care approach comprising of appropriate interventions can be initiated for treatment.
Here’s what Dr Hrishikesh Pai, Trustee, International Federation of Gynecologists and Obstetricians (FIGO) for Asia Oceania region, Immediate Past President of Indian Federation of Gynecologists and Obstetricians (FOGSI), has to say.
PPH remains as one of the leading cause of maternal mortality globally and in India. The global sustainable development goals (SDG) target 3.1 calls for reduction of maternal mortality ratio (MMR) to less than 70 per 100,000 live births by 2030 with some states in India already achieving it and many more working towards it.
EARLY DETECTION AND COLLABORATION ARE KEY
In the realm of obstetrics, PPH stands as a critical challenge, demanding swift and coordinated efforts to ensure the well-being of both mother and child. Recognizing the multifaceted nature of this obstetric emergency, healthcare providers are increasingly turning to a multidisciplinary approach, where specialists from various fields collaborate seamlessly to navigate the complexities of PPH management.
By integrating the expertise of various healthcare professionals, this approach aims to enhance the prevention, early detection, and management of PPH, ultimately reducing the associated morbidity and mortality.
COLLABORATION EXTENDS BEYOND THE ACUTE PHASE
Improving health care for women during childbirth in order to prevent and treat postpartum haemorrhage is an essential step towards the achievement of the Millennium Development Goals. This collaborative strategy brings together obstetricians, midwives, nurses, anesthesiologists, and other healthcare professionals to create a seamless continuum of care aimed at early detection, prompt intervention, and improved outcomes for mothers at risk of postpartum haemorrhage.
According to the multidisciplinary consensus statement, the prediction of postpartum haemorrhage is difficult and there is no single risk factor except abnormal placentation. Despite number of contributing risk factors (multiple pregnancies, history of PPH, pregnancy-induced hypertension, chorioamnionitis, episiotomy, pre-labour caesarean section, macrosomia, and operative vaginal delivery), postpartum haemorrhage can develop unpredictably without any risk factor.
The foundation of a successful multidisciplinary approach to PPH management lies in comprehensive training and education. Healthcare providers across disciplines must receive regular updates on evidence-based practices, emergency protocols, and the use of advanced technologies and medications for haemorrhage control. This ensures that every member of the healthcare team is equipped with the knowledge and skills necessary to respond swiftly and effectively to PPH scenarios.
Central to the multidisciplinary approach is the establishment of clear communication channels and protocols for seamless coordination during labor and delivery. Obstetric teams, including obstetricians, midwives, and labor nurses, collaborate closely to monitor labor progression, assess risk factors for PPH, and initiate preventive measures such as active management of the third stage of labor (AMTSL) and early administration of uterotonic agents.
In high-risk cases or when PPH occurs, an integrated response involving obstetricians, anesthesiologists and transfusion specialists is crucial. Immediate access to blood products, advanced haematologists & surgeons in multidisciplinary team for interventions such as uterine artery embolization or hysterectomy can be life-saving. Multidisciplinary teams work in tandem, ensuring rapid assessment, resuscitation, and definitive management tailored to each patient’s needs.
Beyond the acute phase of PPH management, ongoing collaboration among healthcare providers is vital for postpartum care and follow-up. This includes monitoring for potential complications, providing psychological support to mothers and their families, and facilitating access to long-term care and counselling if needed.
CONTINUOUS IMPROVEMENT FOR BETTER OUTCOMES
The success of a multidisciplinary approach to PPH hinges on continuous quality improvement initiatives and data-driven feedback loops. Regular audits, case reviews, and simulation exercises identify areas for enhancement, refine protocols, and reinforce best practices, ultimately contributing to better outcomes and reduced maternal mortality rates.
A GLOBAL ROADMAP FOR IMPROVED PPH CARE
In recognition of the growing need for global action, WHO, in partnership with multiple stakeholders, has crafted a roadmap from 2023 to 2030 to improve the quality of PPH care.
In conclusion, the multidisciplinary approach to addressing PPH in maternal healthcare represents a collaborative synergy of expertise, communication, technology, and continuous learning. By working together seamlessly across disciplines, healthcare providers can significantly impact maternal outcomes, save lives, and contribute to a safer and healthier environment for mothers and their newborns.