Interventions for Maternal haemorrage

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Age Cohort: 5 - 11 years

Health Promotion	Disease Prevention	Diagnostic	Curative	Rehabilitative	Palliative
Community Level
Community sensitization on dangers of haemorrhage Maternal haemorrhage posters at the community * Promoting skilled birth attendance	Encourage regular ANC visits * Timely referral of high risk pregnant women * Educate pregnant women and family members to avoid activities that lead to higher risk pregnancy conditions e.g. lifting and carrying heavy load, domestic fighting, laundry boards etc. * Encourage use of maternity waiting homes for high-risk pregnant women		Early referral of haemorrhage cases
Primary Care
Sensitization on dangers of haemorrhage * Maternal haemorrhage posters at the health facilities * Promoting skilled birth attendance	Encourage regular ANC visits * Timely referral of high-risk pregnant women Educate pregnant women and family members to avoid activities that lead to higher risk pregnancy conditions e.g., lifting and carrying heavy load, domestic fighting, laundry boards etc. Encourage use of maternity waiting homes for high-risk pregnant women		Active management of third stage labour to prevent postpartum haemorrhage Prophylactic use of uterotonics (oxytocin)to prevent PPH Manual removal of placenta and retained products * Open an intravenous access, urinary catheterization * Early referral of haemorrhage cases
Referral Facility: General
Sensitization on dangers of haemorrhage * Maternal haemorrhage posters at the health facilities * Promoting skilled birth attendance	Encourage regular ANC visits * Timely referral of high-risk pregnant women		Active management of third stage of labour Prophylactic uterotonics for uterine contraction Management of postpartum haemorrhage Uterine tamponade to exert pressure from within the uterus * Fluid replacement for the resuscitation of women with PPH Use of Non-pneumatic antishock garment (NASG) to stabilize women with hypovolemic shock Surgical interventions such as compression sutures or subtotal hysterectomy.
Referral Facility: Specialist
Sensitization on dangers of haemorrhage Maternal haemorrhage posters at the hospitals * Promoting skilled birth attendance * Training of health workers on the dangers of maternal haemorrhage	Timely referral and improved responsiveness to patients * Delivery of high risk women in maternity waiting homes * Postpartum abdominal uterine tonus assessment for early identification of uterine atony		Active management of third stage of labour Prophylactic uterotonics for uterine contraction Management of postpartum haemorrhage Uterine tamponade to exert pressure from within the uterus * Fluid replacement for the resuscitation of women with PPH Use of Non-pneumatic antishock garment (NASG) to stabilize women with hypovolemic shock Surgical interventions such as compression sutures or subtotal hysterectomy.

Age Cohort: 25 - 59 years

Health Promotion	Disease Prevention	Diagnostic	Curative	Rehabilitative	Palliative
Community Level
Community sensitization on dangers of haemorrhage * Maternal haemorrhage posters at the community * Promoting skilled birth attendance	Encourage regular ANC visits Timely referral of high risk pregnant women * Educate pregnant women and family members to avoid activities that lead to higher risk pregnancy conditions e.g. lifting and carrying heavy load, domestic fighting, laundry boards etc. * Encourage use of maternity waiting homes for high-risk pregnant women		Early referral of haemorrhage cases
Primary Care
Sensitization on dangers of haemorrhage * Maternal haemorrhage posters at the health facilities * Promoting skilled birth attendance	Guidance on lifestyle modifications, healthier diet, quitting smoking and alcohol, exercise. Screening and treatment of CVD risk factors Close monitoring of patients on anticoagulant and antiplatelet medications		Active management of third stage labour to prevent postpartum haemorrhage * Prophylactic use of uterotonics (oxytocin) to prevent PPH * Manual removal of placenta and retained products * Open an intravenous access, urinary catheterization * Early referral of haemorrhage cases
Referral Facility: General
Sensitization on dangers of haemorrhage * Maternal haemorrhage posters at the health facilities * Promoting skilled birth attendance	Encourage regular ANC visits * Timely referral of high-risk pregnant women		Active management of third stage of labour Prophylactic uterotonics for uterine contraction Management of postpartum haemorrhage Uterine tamponade to exert pressure from within the uterus Fluid replacement for the resuscitation of women with PP * Use of Non-pneumatic antishock garment (NASG) to stabilize women with hypovolemic shock Surgical interventions such as compression sutures or subtotal hysterectomy.
Referral Facility: Specialist
			Active management of third stage of labour Prophylactic uterotonics for uterine contraction Management of postpartum haemorrhage Uterine tamponade to exert pressure from within the uterus Fluid replacement for the resuscitation of women with PP * Use of Non-pneumatic antishock garment (NASG) to stabilize women with hypovolemic shock Surgical interventions such as compression sutures or subtotal hysterectomy.

Age Cohort: 12 - 24 years

Health Promotion	Disease Prevention	Diagnostic	Curative	Rehabilitative	Palliative
Community Level
Community sensitization Posters on dangers of haemorrhage * Promote skilled birth attendance	Support regular ANC attendance Support delivery in health facility * Timely referral of high-risk pregnant women Promote use of maternity waiting homes for high-risk pregnant women	Recognition signs and symptoms of Maternal haemorrhage	Misoprostol by community health care workers Immediate transfer to a higher-level health care facility		Support for physical and emotional recovery
Primary Care
Health education on risk factors and prevention methods of maternal haemorrhage * Promote skilled birth attendance	Regular quality ANC Active management of the third stage of labour (AMTSL). * Uterotonics during the third stage of labour Preventive misoprostol	History physical Examination Complete blood cell (CBC) count	Vital sign monitoring Active management of the third stage labour Prophylactic uterotonics Manual removal of placenta and retained products * An intravenous access opening, Urinary catheterization * Recognition of danger signs followed by immediate transfer to a higher-level health care facility		Support for physical and emotional recovery
Referral Facility: General
Health education on risk factors and prevention methods of maternal haemorrhage * Promote skilled birth attendance	Active management of the third stage of labour (AMTSL) * Prophylactic Uterotonics during the third stage of labour Postpartum abdominal uterine tonus assessment for early identification of uterine atony	History Physical examination Complete blood cell (CBC) count Coagulation tests Renal function tests Electrolytes Blood grouping Ultrasound	Vital signs monitoring Active management of third stage of labour Uterotonics, Manual removal of placenta, Uterine massage * Uterine tamponade, Isotonic crystalloids for fluid replacement Timely replacement of heavy blood loss Non-pneumatic antishock garment		Support for physical and emotional recovery
Referral Facility: Specialist
Health education on risk factors and prevention methods of maternal haemorrhage * Promote skilled birth attendance	Active management of the third stage of labour (AMTSL). * Prophylactic uterotonics during the third stage of labour Postpartum abdominal uterine tonus assessment for early identification of uterine atony	History Physical examination Complete blood cell (CBC) count Coagulation tests Renal function tests Electrolytes Blood grouping Ultrasound	Vital signs monitoring Active management of third stage of labour Uterotonics (e.g., oxytocin) Manual removal of placenta, Uterine massage * Uterine tamponade, Isotonic crystalloids for fluid replacement Timely replacement of heavy blood loss Non-pneumatic antishock garment (NASG) Compression sutures Ligation of uterine, ovarian, or iliac artery		Support for physical and emotional recovery