1. Callister, Lynn Clark PhD, RN, FAAN

Article Content

Postpartum hemorrhage (PPH) is the major cause of maternal mortality in the world, especially in low-income countries (World Health Organization [WHO], 2023). This includes Niger in West Africa, which is severely under resourced, with an estimated maternal mortality rate of 441 per 100,000 live births and 32% of maternal deaths due to PPH (Irinyenikan, 2023; WHO, 2023). Niger was the first country to institute a countrywide comprehensive program implementing an innovative, low-cost public health strategy to reduce deaths from PPH (Seim et al., 2023). The nationwide initiative includes birth preparedness through a complications procedure plan for health care providers and maternal education (Seim et al., 2023). Childbearing women in their third trimester are given misoprostol to be used if they give birth outside a health care facility and are experiencing severe bleeding within 24 hours of giving birth. If continuing to hemorrhage, an inflated condom tamponade is inserted, and if necessary, a noninflatable antishock garment is implemented (Seim et al., 2023).


These strategies are recommended by WHO (Weeks et al., 2022) and have been evaluated by Kellie et al. (2020). In Niger, the interventions are packaged and available to as many childbearing women as possible prior to giving birth. A 72-month longitudinal outcomes evaluation was conducted to determine the effects of this multifaceted intervention for management of primary PPH in Niger with 582,488 study participants. Results showed a dramatic reduction in morbidity and mortality related to PPH (Seim et al., 2023). Positive outcomes have been sustained for 6 years (Seim et al., 2023). Findings of this initiative are comparable to the current rates of maternal mortality attributed to primary PPH in the United States (Bienstock et al., 2021). According to Irinyenikan (2023, p. e288), "...interventions described in this study can be of tremendous help in low-resource countries to curb the consequences of the morbidity and mortality associated with primary PPH...and can be considered a standard operating procedure until randomized trials are carried out especially in low-resource countries."


Nurses are involved in educational efforts such as teaching peripartum women and health care providers about prevention and management of PPH. The Association of Women's Health, Obstetric, and Neonatal Nurses (AWHONN) was a leader in developing a PPH Project Bundle which includes a hemorrhage risk prediction tool to quantify women's risk for PPH. AWHONN has implemented a number of educational initiatives about PPH for nurses and other health care providers (Bingham et al., 2018), including members of the American College of Obstetricians and Gynecologists (Ende & Butwick, 2021). The AWHONN PPH risk assessment tool is part of the medical record and admission process in many hospitals in the United States. Nurses are part of health care teams implementing PPH prevention strategies and research teams conducting randomized clinical trials in low- and middle-income countries throughout the world.




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