Prevention and treatment of postpartum hemorrhage in low-resource settings

This statement does not change the 2 previous statements on management of the third stage of labor (both available at http://www.figo. org/projects/prevent/pph): ICM/FIGO Joint Statement – Management of the Third Stage of Labour to Prevent Post-partum Haemorrhage [1]; and ICM/FIGO Joint Statement – Prevention and Treatment of Postpartum Haemorrhage: New Advances for Low Resource Settings [2]. The following guideline provides a comprehensive document regarding best practice for the prevention and treatment of postpartum hemorrhage (PPH) in low-resource settings. FIGO is actively contributing to the global effort to reducematernal death and disability around the world. Its mission statement reflects a commitment to the promotion of health, human rights, and wellbeing of all women—especially those at greatest risk for death and disability associated with childbearing. FIGO promotes evidence-based interventions that, when applied with informed consent, can reduce the incidence of maternal morbidity and mortality. This statement reflects the best available evidence, drawn from scientific literature and expert opinion, on the prevention and treatment of PPH in low-resource settings. Approximately 30% (in some countries, over 50%) of direct maternal deaths worldwide are due to hemorrhage, mostly in the postpartum period [3]. Most maternal deaths due to PPH occur in lowincome countries in settings (both hospital and community) where there are no birth attendants or where birth attendants lack the necessary skills or equipment to prevent and manage PPH and shock. The Millennium Development Goal of reducing the maternal mortality ratio by 75% by 2015 will remain beyond our reach unless we prioritize the prevention and treatment of PPH in low-resource areas [4]. FIGO endorses international recommendations that emphasize the provision of skilled birth attendants and improved obstetric services as central to efforts to reduce maternal and neonatal mortality. Such policies reflect what should be a basic right for every woman. Addressing PPH will require a combination of approaches to expand access to skilled care and, at the same time, extend life-saving interventions