How to improve the quality of postpartum hemorrhage management in West Africa ?

Abstract

The maternal mortality ratio in West Africa is the highest in the world and postpartum hemorrhage (PPH) is the leading direct cause of maternal mortality. The general objective of this work was to provide knowledge to improve the management of PPH in hospitals in West Africa. Firstly, we have highlighted that maternal risk factors for morbidity and mortality related to the PPH found in high-resource countries were generalizable to the context of West Africa. Furthermore, our analysis suggests that the qualification of the doctor in charge of the maternity unit (general practitioner versus obstetrician) has a decisive impact on the maternal issue in this context. Then, we showed that injection of oxytocin within ten minutes after the diagnosis of PPH was a key factor for improving maternal health in Benin and Mali. Rapid diagnosis of PPH and better monitoring of the immediate postpartum period were also important. Finally, we set up a pilot study to assess the feasibility of a randomized controlled trial (RCT), which aims to test the effectiveness of uterine tamponade with condom catheter in the postpartum hemorrhage management in this region. The results showed that f a RCT was feasible and provided additional knowledge to optimize the research protocol. Thus, we have identified a number of factors on which action should be taken to improve the quality of PPH management.