GIRMMAHP Initiative

Postpartum Hemorrhage (PPH) Working Group MeetingMarch 20, 2006

Albert Figueras

Washington, March 20, 2006

Catalan acronym for:

International Group for Reducing Maternal Mortality

Associated to Postpartum Hemorrhage

Support:

Participant Researchers

Catalonia: Albert Figueras (Coordination)

Nicaragua: Edgar Narváez

Dominican Republic: Angiolina Camilo

Peru: Susana Vásquez

Argentina: Mabel Valsecia

Guatemala: José María del Valle

1.- The reasons that explain the intervention

- shaming figures

- overload of scientific information

2.- Logistics of the intervention

3.- Preliminar results: Nicaragua

1.- The reasons that explain the intervention

- shaming figures

- overload of scientific information

2.- Logistics of the intervention

3.- Preliminar results: Nicaragua

Several figures

- Nicaragua (2001):

107 deaths/100,000 live births

(57% due to PPH)

- Dominican R.: 150/100,000 l.b.

Additional LA figures: MM (2000)

Bolivia 420 /100,000 l.b.

Peru 410 /100,000 l.b.

Brazil 260 /100,000 l.b.

Guatemala 240 /100,000 l.b.

Ecuador 210 /100,000 l.b.

Argentina 82 /100,000 l.b.

Additional LA figures: MM (2000)

Bolivia 420 /100,000 l.b.

Peru 410 /100,000 l.b.

Brazil 260 /100,000 l.b.

Guatemala 240 /100,000 l.b.

Ecuador 210 /100,000 l.b.

Argentina 82 /100,000 l.b.

Italy 5 /100,000 l.b.

Spain 4 /100,000 l.b.

Maternal mortality is an indicator of social and economic inequity

PPH prevention:

identification of risk factors - pregnancy

- intra-partum

active managing of 3rd stage

- uterotonics (oxitocyn, ...)

- controlled cord traction

- uterine massage after delivery of the placenta

- periodic control of constants

PPH Managing:

- appropriate causal diagnosis

- uterine atonia / bleeding

- vaginal lesions

- coagulation disorders

- general support measures

It does exist sufficient and appropriate high-quality scientific information on how to prevent PPH

Why mortality due to PPH is so high in so many countries?

It does exist sufficient and appropriate high-quality scientific information on how to prevent PPH...

Access to health system Quality of care

Risk factors identification

Pregnancy controls

Knowledge

Medicines

Information

Why mortality due to PPH is so high in so many countries?

Participating in network means:

- more efficiency than individual work

- preservation of individualities

1.- The reasons that explain the intervention

- shaming figures

- overload of scientific information

2.- Logistics of the intervention

3.- Preliminar results: Nicaragua

Scientific information

and

information about medicines

rational medicines prescription and use

(also valid for medicines, medical devices, procedures...)

• appropriate medicine for the patient who need it

• at the appropriate dosage and duration

• giving enough information about how to use it to the patient

colleages

routine

obsolescence

patients

place: public / private

reps.

- information today

- medicines and practice information today

- Evidence-Based Medicine (use and abuse)

recommended “daily dose” of reading

scientific papers in order to be

appropriately updated (or to avoid

obsolescence) in one’s own speciality:

17 papers / day

M. Rawlins. UK’s NICE Chairman

Consequences

- therapeutic failure

- obsolete practices

- low quality care

- innecessary waste of resources

... without being conscious of this

How to measure the quality of real practice?

Drug utilization studies (DUS)

(audit studies, observational studies)

- easy to do

- statistically simple

- cheap

- quick

initial situation

hypothesis

DUS

intervention

results, impact

?

Clinical guidelines

why adherence is low?

1.- The reasons that explain the intervention

- shaming figures

- overload of scientific information

2.- Logistics of the intervention

3.- Preliminar results: Nicaragua

http://www.girmmahp.net

Farmacología Medicina- UNNE

1.- The reasons that explain the intervention

- shaming figures

- overload of scientific information

2.- Logistics of the intervention

3.- Preliminary results: Nicaragua