Technical briefs/newsletters

Global AMTSL Surveys Reports

Global Survey on the Management of the Third Stage of Labor Reports These studies aim to provide ministries of health and their partners with data about the actual practice of AMTSL, including policy, provider-support, and supplies and logistics, along with the descriptive information necessary to assess AMTSL practices and identify barriers to its use in their country.

Oral misprostol in preventing postpartum haemorrhage in resource-poor communities: a randomized controlled trial

The focus of this article is on the potential alternative to oxytocin, oral misprostol, in preventing postpartum haemorrhage in home-birth settings. The study was conducted in rural India where randomised trials were conducted with midwives undertaking the deliveries, administering the study drug and then measuring blood loss.

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A practical approach to timing cord clamping in resource poor settings

This brief report details a practice guideline to cord clamping for resource poor countries for singleton vaginal deliveries. The guideline is based on published reviews, trials and evidence. It also delivers answers to questions regarding health effects of delayed cord clamping.

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Cost-effectiveness of two maternal mortality interventions in rural India

Poster by Tori Sutherland MPH and David M. Bishai MD MPH PhD, Department of Population, Family and Reproductive Health Sciences, Johns Hopkins Bloomberg School of Public Health

Tori Sutherland presented this poster at the annual PPH working group meeting in Washington DC on April 6, 2009

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Letter of support for misoprostol to be added to WHO's EML for PPH prevention

In December 2008, Gynuity Health Projects along with Venture Strategies for Health and Development submitted an application for misoprostol to be added to the WHO Essential Medicine List (EML) for its postpartum hemorrhage prevention indication in section 22.01.00.00 "Oxytocics". POPPHI played an active role in supporting this effort by putting out a call for letters of support and then coordinating, at WHO's suggestion, a letter with multiple signatures. There were 20 signatures from various organizations on the letter.

 

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Pilot use of oxytocin in a Unijectdevice for AMTSL in Mali

Evaluation of the safety and feasibility of a new delivery technology December 2008

This report describes use of the BD Uniject™ device1 prefilled with 10 international units (IU) of oxytocin for actively managing the third stage of labor in selected health centers in Mali. Although this single-dose, autodisable injection device has previously been used for tetanus toxoid vaccination in Mali, the Ministry of Health lacked documentation of the safety and feasibility of using the device to deliver oxytocin for active management of the third stage of labor (AMTSL).

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Use of oxytocin and misoprostol for induction or augmentation of labor in low-resource settings: A working paper review

The focus of this working paper is on induction and augmentation in the developing world, and the inclusion of data from developed countries was intended only for comparative purposes.  The impetus for this working paper is the recent call for expanded availability of oxytocin and misoprostol to all maternity settings in developing countries for the purposes of active management of the third stage of labor (AMTSL) to reduce postpartum hemorrhage, coupled with concerns that these drugs would then be widely available for induction and augmentation. The aim of this working paper is to compile in one place; definitions, recommended methods, rates, trends, indications and maternal and perinatal risks associated with induction and augmentation. 

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WHO Recommendations on the Prevention of Postpartum Hemorrhage: A summary of the results from a WHO Technical Consultation

The World Health Organization (WHO) held a Technical Consultation in Geneva to discuss the various issues related to the prevention of PPH and to develop recommendations. This document highlights key recommendations from the report.

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Newsflash

Newsflash: Oxytocin can take the heat, more storage flexibility with TTI: PATH's HealthTech program recently presented data showing that the time temperature exposure indicators (TTIs) used with almost all vaccines purchased by the United Nations Children’s Fund may also be used with oxytocin.

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Uniting Africans to Save Women's Lives from Postpartum Hemorrhage: Historic gathering to address world's highest rate of maternal mortality. JHPIEGO News Release

This news brief speaks to the urgent need to address the high maternal mortality rate in Africa and describes the ACCESS program which is a leading effort worldwide to reduce maternal mortality through a combination of approaches. The news brief also introduces a groundbreaking conference that was organized by the ACCESS Program in partnership with the Regional Centre for Quality of Health Care (RCQHC), the East, Central, and Southern Africa Health Secretariat (ECSA), and POPPHI.

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WHO Recommendations for the Prevention of Postpartum Haemorrhage

This document describes the technical consultation process, evaluates the evidence using the GRADE methodology, and provides the full set of recommendations from the World Health Organization (WHO) Technical Consultation on the Prevention of Postpartum Haemorrhage held in Geneva October 18 to 20, 2006. It makes recommendations to continue WHO's support for AMTSL, identifies who can provide AMTSL, and gives support to the use of misoprostol for prevention of postpartum hemorrhage, based on the evidence.

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Saving women’s lives: evidence-based recommendations for the prevention of postpartum haemorrhage

This document reports on the WHO Technical Consultation on Prevention of PPH held from October 18 to 20, 2006 and gives recommendations from WHO on how to prevent postpartum hemorrhage. In addition to the recommendation that all skilled birth attendants (SBAs) should provide active management of the third stage of labor (AMTSL), it was also recommended that a uterotonic (either oxytocin or misoprostol) can be used alone to prevent postpartum hemorrhage, when there is not a trained SBA to provide AMTSL. The full Technical Consultation recommendations include that the uterotonic can be provided by a trained health worker (it does not state skilled birth attendant).

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MPS Technical Update: Prevention of Postpartum Haemorrhage by Active Management of Third Stage of Labour (October 2006)

This WHO document outlines WHO's recommendation that active management of the third stage of labor be offered by all skilled attendants at every birth, giving the background, evidence, and steps for the intervention.

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Misoprostol for Prevention of Postpartum Hemorrhage: An Evidence-based Review by the United States Pharmacopeia (USP)

This report provides the evidence tables behind the USP recommendation that prevention of postpartum hemorrhage be included as an indication in the USP Drug Information monograph on misoprostol.

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Misoprostol for Prevention of Postpartum Hemorrhage: An Evidence-Based Review by U.S. Pharmacopeia (USP)

This poster summarizes the USP review of the evidence and conclusions on the use of misoprostol for the prevention of postpartum hemorrhage.

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Directions in Global Health December 2006 issue

This PATH publication highlights POPPHI's work on preventing postpartum hemorrhage.

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Essential Medicines for Reproductive Health: Guiding Principles for Inclusion on National Medicines Lists

This publication from WHO, the United Nations Population Fund, and PATH provides information on the process for including reproductive health medicines on national essential medicines lists at the country level based on the essential medicines concept. Injectable oxytocin is described on pages 102 to 104 of the document.

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Stability of injectable oxytocics in tropical climates Results of field surveys and simulation studies on ergometrine, methylergometrine and oxytocin

This WHO publication presents information on the stability of uterotonic drugs for active management of the third stage of labor in tropical climates.

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Active Management of the Third Stage of Labor: A Simple Practice to Prevent Postpartum Hemorrhage

This Global Health Technical Brief presents information on postpartum hemorrhage and active management of the third stage of labor.

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Preventing Postpartum Hemorrhage: Managing the Third Stage of Labor

This issue of Outlook, PATH's quarterly reproductive health newsletter, reviews preventing postpartum hemorrhage through active management of the third stage of labor.

English version (75 KB PDF)

Versión español (123 KB PDF)

Version française (66 KB PDF)

Indonesian version (562 KB PDF)

Misoprostol Use in Obsetrics and Gynecology

This issue of Outlook, PATH's quarterly reproductive health newsletter, provides evidence-based information on the emerging use of misoprostol in obstetrics and gynecology.

English version (562 KB PDF)

Versión español (182 KB PDF)

First Aid for Women and Newborns Where Home Birth is Necessary or Common

This Global Health Technical Brief presents information on the Home Based Life Saving Skills program.

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Managing Complications in Pregnancy and Childbirth A guide for midwives and doctors

This World Health Organization manual offers important information on complications including postpartum hemorrhage.

English version

Version française

Versión español

Misoprostol and Postpartum Hemorrhage (PPH) Research, April 2007, Version 7

This document, compiled by POPPHI, provides information of studies on the use of misoprostol in the prevention and treatment of postpartum hemorrhage, as of April 2007.

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