maternal health innovations_eltahir_5.13.11

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Prevention and Management of PPH: Utilizing Uterotonics and the Non-Pneumatic Anti-Shock Garment (NASG)Dr. Abdelhadi Eltahir, Sr. Advisor for Maternal and Newborn Health

CORE Group Spring MeetingEQUITY IN HEALTH: ENSURING ACCESS, INCREASING USE Radisson Hotel, Baltimore May 9 to 13, 2011




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Pioneering and advocating

Contraception

Maternal & Newborn Health

HIV and AIDS

Adolescents

Abortion & Postabortion Care

Advocacy

Building capacity and creating innovations

Engaging communities and valuing their roles

People everywhere have the right and opportunity to live a healthy sexual and reproductive life

Approach OutcomeAreas of Involvement




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The Clinical and Community Action Model for PPH (CC-PPH)

• Early government support to ensure buy-in and adoption

• Expanding clinical staff capacity to improve quality of services

• Working with the community to overcome barriers

OVERVIEW UTEROTONICS SHOCK & NASG OUR WORK




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Why PPH?


Postpartum hemorrhage (PPH) is a priority Issue for Pathfinder because:

1. PPH is a major cause of maternal

mortality (25% to 60%),

2. PPH kills fast (as little as 2 hours from

onset to death),

3. Death from PPH is preventable with

prompt recognition and treatment

4. Addressing PPH comprehensively leads

the way to effectively addressing all

causes of maternal mortality.

Here is the baby, but where is the mother?




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Uterotonic drugs


Uterotonics are used to: Prevent PPH when applying active

management of the third stage of labor (AMTSL),

Induce or augment labor by;• Increasing frequency of contractions

during labor, • Increasing intensity of contractions

during labor, and Enhance uterine contractions

following spontaneous abortion.




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Uterotonic drugs


• The commonly used uterotonics are:

o Oxytocin

o Ergometrine or syntometrine

o Misoprostol

• Injectable uterotonic drugs are administered IM or IV

• Tablet uterotonics are given orally, vaginally or rectally (for PPH)




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Retaining effectiveness and potency


Uterotonic Recommended temperature

Shelf-life outside refrigerator

Recommended light exposure

Effects of light exposure

Ergometrine

• Injectable form best kept in a refrigerator, between 2–8°C

• Should not be frozen

May be kept outside the refrigerator in closed boxes and protected from light for up to one month at 30°C

Should be kept out of light

When exposed to light, even indirect light, ergometrine and methylergometrine rapidly lose potency.

Oxytocin• Injectable form

best kept in a refrigerator, between 2–8°C

May be kept outside the refrigerator at a maximum of 30°C for up to three months

When exposed to light oxytocin loses negligible amounts of potency.

Syntometrine • Should not be frozen

May be kept outside the refrigerator in closed boxes and protected from light for up to one month at 30°C

Should be kept out of light

Source: WHO, USAID, POPPHI




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Shift to best practice in use of uterotonics: Oxytocin


• Oxytocin is the drug of choice for AMTSL

• Administering oxytocin immediately after childbirth has led to significant impact in preventing and reducing PPH

• Demand remains high for AMTSL




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Addressing Hypovolemic Shock: How the non-pneumatic anti-shock garment (NASG) works





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The non-pneumatic anti-shock garment (NASG)


• The NASG shunts blood accumulating in the lower extremities back up to the vital organs, including the brain, heart, and lungs

• Women in shock are placed in the garment to temporarily stabilize them during transportation or while waiting for surgery / other treatment

• It is made of neoprene and Velcro, with a firm ball at the abdomen which compresses the uterus to decrease bleeding

• It can be used at all levels of health facilities (public and private) and in ambulances




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Hypovolemic shock and how the NASG works

Severe bleeding deprives vital organs of oxygen as blood accumulates in the lower body


The NASG reverses shock by shunting blood from the lower extremities and abdomen to vital organs




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Maternal mortality per 100,000 live births

CC-PPH model coverage


India

PeruBangladesh

TanzaniaNigeria




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Challenges in implementing the NASG


• Implementation of the garment requires frequent training and supportive supervision

• A danger of using the garment lies in the potential for untrained providers to remove it at the wrong time, causing rapid decompression and shock

• Logistic issues include getting the garment returned to it’s “home” site, properly cleaned, dried and stored, for use by the next PPH emergency case




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60 LIFELONG50BIRTH 10 20 30 40

Thank you!Let’s make the lives of every mother and child count!

maternal health innovations_eltahir_5.13.11

Health & Medicine

management of pph

community action model

clinical staff capacity

useradisson hotel

quality of services

shock garment nasgdr

abdelhadi eltahir