Stakeholders call for action to stem maternal death arising from PPH


A pregnant woman during birth

Stakeholders have called on the government and others to advocate policies and actions towards ending maternal death arising from Post-Partum Hemorrhage (PPH).

According to reports, PPH is the leading cause of maternal mortality worldwide, but it can be stopped if the right actions are taken at the right time.

A consultant Obstetrician and Gynaecologist at the MSI Reproductive Choices in London, United Kingdom, Dr. Adebayo Awoniyi, said that effective prevention and management strategies were crucial to improving maternal health outcomes in Nigeria.

Awoniyi listed uterine atony, trauma, retained placental tissue, coagulation disorders, among others, to be the primary causes of PPH.

“PPH is defined as the loss of more than 500ml of blood within 24 hours after vaginal delivery or more than 1000ml after cesarean section. It accounts for a substantial proportion of maternal deaths globally, with Nigeria having one of the highest mortality rates. Addressing this problem is essential for achieving the Sustainable Development Goal (SDG) of reducing the global maternal mortality ratio,” Awoniyi stated.

According to him, “Preventing maternal deaths from postpartum hemorrhage in Nigeria requires a multi-faceted approach, including improved healthcare infrastructure, trained personnel, efficient supply chains, community engagement, and strong policy support. By addressing these challenges, Nigeria can make significant strides toward reducing maternal mortality and improving the health and well-being of mothers and their families.

“More importantly, we must work towards prevention, and some actions to take will include good antenatal care which involves regular antenatal visits; monitoring and managing risk factors such as anemia and hypertensive disorders; iron and folic acid supplementation to prevent anemia.

“It is also good to use skilled birth attendants. This involves training of health workers, ensuring that midwives and obstetricians are skilled in PPH management and prevention, and also ensuring the availability of essential medicines and surgical interventions.

“There is also the Active Management of the Third Stage of Labor (AMTSL), which includes the use of Oxytocic, Prophylactic use of uterotonic drugs to prevent uterine atony, proper technique to deliver the placenta and uterine massage.

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“The World Health Organisation (WHO) has however recommended use of the E-MOTIVE bundle, which is a modification of the response to detection and management of women with PPH. E-MOTIVE stands for E- Early bleeding detection using a calibrated drape; Uterine massage; O- Use of medication (Oxytocic); T -Use of Tranexamic acid; IV- Intravenous fluids; E-Genital tracts examination and escalation when necessary. This new approach advocates that all components of the bundle are given in the shortest possible time without waiting for a response to individual interventions.”

Chairman of the Lagos State Advocacy Group on women’s health, Ayo Adebusuyi, called for more funding of programmes to stem maternal death.

According to him, the policies and programmes already exist, but inadequate funding is preventing them from being effective.

He noted: “Our women’s health initiative focuses on women’s health generally, though post-partum bleeding tops the chart on causes of maternal deaths. The overriding goal is to reduce maternal death in Lagos State by 20 per cent, by the year 2030.

“We agreed on many specific smart objectives, one of which is to push for more funding because whatever we are talking about needs funding to be effective. There are many policy guidelines on maternal health, but funding is paramount to make them effective…”

The Lagos State government however said it is working to domesticate the EMOTIVE bundle by the third quarter of this year.

Permanent Secretary in the Ministry of Health, Dr. Olusegun Ogboye said: “We are set to domesticate the guidelines at state level by third quarter of the year. We have also reviewed and are updating our protocols with the obstetrics and gynaecology departments in all state-owned hospitals to include the EMOTIVE bundle in their treatment modules.

“We are also working to bring stakeholders together to review it and adapt it for our own situation in Lagos State.”

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