The Safety and Feasibility of a Family First Aid Approach for the Management of Postpartum Hemorrhage in Home Births: A
- PDF / 607,308 Bytes
- 9 Pages / 595.276 x 790.866 pts Page_size
- 40 Downloads / 171 Views
The Safety and Feasibility of a Family First Aid Approach for the Management of Postpartum Hemorrhage in Home Births: A Pre‑post Intervention Study in Rural Pakistan Meighan Mary1 · Sadiqua Jafarey2 · Rasha Dabash1 · Imtiaz Kamal2 · Arjumand Rabbani2 · Dina Abbas1 · Jill Durocher1 · Yi‑Ling Tan1 · Beverly Winikoff1 Accepted: 6 November 2020 © The Author(s) 2020
Abstract Objective To evaluate the safety and feasibility of a Family First Aid approach whereby women and their families are provided misoprostol in advance to manage postpartum hemorrhage (PPH) in home births. Methods A 12-month prospective, pre-post intervention study was conducted from February 2017 to February 2018. Women in their second and third trimesters were enrolled at home visits. Participants and their families received educational materials and were counseled on how to diagnose excessive bleeding and the importance of seeking care at a facility if PPH occurs. In the intervention phase, participants were also given misoprostol and counselled on how to administer the four 200 mcg tablets for first aid in case of PPH. Participants were followed-up postpartum to collect data on use of misoprostol for Family First Aid at home deliveries (primary outcome) and record maternal and perinatal outcomes. Results Of the 4008 participants enrolled, 97% were successfully followed-up postpartum. Half of the participants in each phase delivered at home. Among home deliveries, the odds of reporting PPH almost doubled among in the intervention phase (OR 1.98; CI 1.43, 2.76). Among those reporting PPH, women in the intervention phase were significantly more likely to have received PPH treatment (OR 10.49; CI 3.37, 32.71) and 90% administered the dose correctly. No maternal deaths, invasive procedures or surgery were reported in either phase after home deliveries. Conclusions The Family First Aid approach is a safe and feasible model of care that provides timely PPH treatment to women delivering at home in rural communities. Keywords Postpartum hemorrhage (PPH) · Misoprostol · PPH management · Home births · Self-care interventions
Significance Statement Misoprostol is effective in treating postpartum hemorrhage. Recent community-based studies have also confirmed that community health workers or birth attendants can diagnose and safely administer misoprostol for PPH management in home deliveries where timely referrals are complicated by a range of factors. This research demonstrates the safety and feasibility of delegating PPH diagnosis and treatment * Meighan Mary [email protected] 1
Gynuity Health Projects, 220 East 42nd Street Suite 710, New York, NY 10017, USA
National Committee for Maternal and Neonatal Health, Karachi, Pakistan
2
using misoprostol to women and their families. The study also demonstrates that innovative self-care approaches to improving access to PPH care within rural communities do not discourage institutional deliveries and, in fact, can promote community engagement and bolster the public health systems’ reach.
Introd
Data Loading...
