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GIRMMAHP Initiative
Postpartum Hemorrhage (PPH) Working Group MeetingMarch 20, 2006
Albert Figueras
Washington, March 20, 2006
Catalan acronym for:
International Group for Reducing Maternal Mortality
Associated to Postpartum Hemorrhage
Support:
Participant Researchers
Catalonia: Albert Figueras (Coordination)
Nicaragua: Edgar Narváez
Dominican Republic: Angiolina Camilo
Peru: Susana Vásquez
Argentina: Mabel Valsecia
Guatemala: José María del Valle
1.- The reasons that explain the intervention
- shaming figures
- overload of scientific information
2.- Logistics of the intervention
3.- Preliminar results: Nicaragua
1.- The reasons that explain the intervention
- shaming figures
- overload of scientific information
2.- Logistics of the intervention
3.- Preliminar results: Nicaragua
Several figures
- Nicaragua (2001):
107 deaths/100,000 live births
(57% due to PPH)
- Dominican R.: 150/100,000 l.b.
Additional LA figures: MM (2000)
Bolivia 420 /100,000 l.b.
Peru 410 /100,000 l.b.
Brazil 260 /100,000 l.b.
Guatemala 240 /100,000 l.b.
Ecuador 210 /100,000 l.b.
Argentina 82 /100,000 l.b.
Additional LA figures: MM (2000)
Bolivia 420 /100,000 l.b.
Peru 410 /100,000 l.b.
Brazil 260 /100,000 l.b.
Guatemala 240 /100,000 l.b.
Ecuador 210 /100,000 l.b.
Argentina 82 /100,000 l.b.
Italy 5 /100,000 l.b.
Spain 4 /100,000 l.b.
Maternal mortality is an indicator of social and economic inequity
PPH prevention:
identification of risk factors - pregnancy
- intra-partum
active managing of 3rd stage
- uterotonics (oxitocyn, ...)
- controlled cord traction
- uterine massage after delivery of the placenta
- periodic control of constants
PPH Managing:
- appropriate causal diagnosis
- uterine atonia / bleeding
- vaginal lesions
- coagulation disorders
- general support measures
It does exist sufficient and appropriate high-quality scientific information on how to prevent PPH
Why mortality due to PPH is so high in so many countries?
It does exist sufficient and appropriate high-quality scientific information on how to prevent PPH...
Access to health system Quality of care
Risk factors identification
Pregnancy controls
Knowledge
Medicines
Information
Why mortality due to PPH is so high in so many countries?
Participating in network means:
- more efficiency than individual work
- preservation of individualities
1.- The reasons that explain the intervention
- shaming figures
- overload of scientific information
2.- Logistics of the intervention
3.- Preliminar results: Nicaragua
Scientific information
and
information about medicines
rational medicines prescription and use
(also valid for medicines, medical devices, procedures...)
• appropriate medicine for the patient who need it
• at the appropriate dosage and duration
• giving enough information about how to use it to the patient
colleages
routine
obsolescence
patients
place: public / private
reps.
- information today
- medicines and practice information today
- Evidence-Based Medicine (use and abuse)
recommended “daily dose” of reading
scientific papers in order to be
appropriately updated (or to avoid
obsolescence) in one’s own speciality:
17 papers / day
M. Rawlins. UK’s NICE Chairman
Consequences
- therapeutic failure
- obsolete practices
- low quality care
- innecessary waste of resources
... without being conscious of this
How to measure the quality of real practice?
Drug utilization studies (DUS)
(audit studies, observational studies)
- easy to do
- statistically simple
- cheap
- quick
initial situation
hypothesis
DUS
intervention
results, impact
?
Clinical guidelines
why adherence is low?
1.- The reasons that explain the intervention
- shaming figures
- overload of scientific information
2.- Logistics of the intervention
3.- Preliminar results: Nicaragua
http://www.girmmahp.net
Farmacología Medicina- UNNE
1.- The reasons that explain the intervention
- shaming figures
- overload of scientific information
2.- Logistics of the intervention
3.- Preliminary results: Nicaragua