Interventions for Obstetric Haemorrhage

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Age Cohort: Pregnancy and newborn
Health Promotion Disease Prevention Diagnostic Curative Rehabilitative Palliative
Community Level
  • Regular age-appropiate ANC focused on maternal and foetal monitoring
  • Food fortification i-maternal nutrition
  • Risk assessment
  • Obstetric Hemorrhage Protocols
  • Emergency response to obstetric care across Health Systems
  • Obstetric care coordination across health systems.
  • Timely referral and improved responsiveness to patients
  • Skilled birth attendance
  • NASG training on the standard emergency obstetric care curriculum for medical, midwifery and nursing students
  • Use of the Non-Pneumatic Anti-Shock Garment (NASG) for shock management and * Life-Threatening Obstetric Hemorrhage
  • Active management of third stage of labour
  • Early NASG application at the Primary Health Center (PHC)
  • Every Second Matters (ESM )- Uterine Balloon Tamponade
  • Aspirin use with caution

• Regular ANC attendance • Delivery in health facility
• Timely referral of high-risk pregnant women
• Promote use of maternity waiting homes for high-risk pregnant women

• History • Observation

Active management of third stage of labour

• Misoprostol by community health care workers • Immediate transfer to a higher-level health care facility

• Psychosocial support for physical and emotional recovery

Primary Care
  • Regular age-appropiate ANC focused on maternal and foetal monitoring
  • Food fortification i-maternal nutrition
  • Risk assessment
  • Obstetric Hemorrhage Protocols
  • Emergency response to obstetric care across Health Systems
  • Obstetric care coordination across health systems.
  • Timely referral and improved responsiveness to patients
  • Skilled birth attendance
  • NASG training on the standard emergency obstetric care curriculum for medical, midwifery and nursing students

• Health education on identification of danger signs of pregnancy including symptoms and prevention of maternal haemorrhage • Promote skilled birth attendance

  • Use of the Non-Pneumatic Anti-Shock Garment (NASG) for shock management and * Life-Threatening Obstetric Hemorrhage
  • Active management of third stage of labour
  • Early NASG application at the Primary Health Center (PHC)
  • Every Second Matters (ESM )- Uterine Balloon Tamponade
  • Aspirin use with caution

• 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

Active management of third stage of labour

  • 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
  • Psychosocial support for physical and emotional recovery
Referral Facility: General
  • Regular age-appropiate ANC focused on maternal and foetal monitoring
  • Food fortification i-maternal nutrition
  • Risk assessment
  • Obstetric Hemorrhage Protocols
  • Emergency response to obstetric care across Health Systems
  • Obstetric care coordination across health systems.
  • Timely referral and improved responsiveness to patients
  • Skilled birth attendance
  • NASG training on the standard emergency obstetric care curriculum for medical, midwifery and nursing students
  • Health education on identification of danger signs of pregnancy including symptoms and
  • prevention of maternal haemorrhage
  • Use of the Non-Pneumatic Anti-Shock Garment (NASG) for shock management and * Life-Threatening Obstetric Hemorrhage
  • Active management of third stage of labour
  • Early NASG application at the Primary Health Center (PHC)
  • Every Second Matters (ESM )- Uterine Balloon Tamponade
  • Aspirin use with caution
  • 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

Active management of third stage of labour

  • 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 (NASG)
  • Compression sutures
  • Ligation of uterine, ovarian or iliac artery
  • Total or subtotal hysterectomy
  • Psychosocial support for physical and emotional recovery
Referral Facility: Specialist
  • Regular age-appropiate ANC focused on maternal and foetal monitoring
  • Food fortification i-maternal nutrition
  • Risk assessment
  • Obstetric Hemorrhage Protocols
  • Emergency response to obstetric care across Health Systems
  • Obstetric care coordination across health systems.
  • Skilled birth attendance
  • NASG training on the standard emergency obstetric care curriculum for medical, midwifery and nursing students
  • Health education on identification of danger signs of pregnancy including symptoms and
  • prevention of maternal haemorrhage
  • Use of the Non-Pneumatic Anti-Shock Garment (NASG) for shock management and * Life-Threatening Obstetric Hemorrhage
  • Active management of third stage of labour
  • Early NASG application at the Primary Health Center (PHC)
  • Every Second Matters (ESM )- Uterine Balloon Tamponade
  • Aspirin use with caution
  • 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

Active management of third stage of labour

  • 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
  • Total or subtotal hysterectomy
  • Psychosocial support for physical and emotional recovery