Next Generation Medical Management of Postpartum Hemorrhage

2019 ◽  
Vol 25 (5) ◽  
pp. 549-555 ◽  
Author(s):  
Jaclyn M. Phillips ◽  
John N. van den Anker ◽  
Homa K. Ahmadzia
Keyword(s):  
Low Income ◽  
Postpartum Hemorrhage ◽  
Medical Management ◽  
Low Income Countries ◽  
Fibrinogen Concentrate ◽  
Childbearing Age ◽  
New Approach ◽  
Patients At Risk ◽  
Target Prevention ◽  
New Generation

Background: Postpartum hemorrhage remains a significant contributor to morbidity and mortality of women of childbearing age worldwide. Trends in both incidence and severity of postpartum hemorrhage are increasing which makes it imperative to identify drugs that could target prevention and/or treatment of these postpartum hemorrhages for women living in high, middle and low-income countries. Methods: We have reviewed current advances in the medical management of postpartum hemorrhage focusing on non-uterotonic therapy. We specifically describe the use and mechanism of action of tranexamic acid (TXA) and fibrinogen concentrate. Furthermore, we address the existing data for using these medications in postpartum hemorrhage, highlighting both strengths and limitations. Results: This review describes a new generation of medications that are promising for the prevention and/or treatment of postpartum hemorrhage. For patients at risk for significant hemorrhage, TXA has been shown to reduce intraoperative blood loss and can be given as a prophylactic agent. For the treatment of postpartum hemorrhage, early use of TXA has the potential to reduce mortality. In addition, some data exists supporting the use of fibrinogen concentrate, though more studies are required to help formulate guidelines for its use. Conclusion: A promising new approach for the management of severe postpartum hemorrhage is using medications that alter coagulation. More data are needed to describe ideal patient populations, dosing, the time of administration, and infusion rate.

scholarly journals Therapies Out of Reach: Anticancer Drugs and Global Trade Regimes

2018 ◽  
Vol 23 (3) ◽  
pp. 371-387
Author(s):  
Dwaipayan Banerjee ◽  
James Sargent
Keyword(s):  
Anticancer Drugs ◽  
Low Income ◽  
Low Income Countries ◽  
High Price ◽  
Global Trade ◽  
Trade Regimes ◽  
History Of ◽  
Policy Analysts ◽  
The Cost ◽  
New Generation

Medical policy analysts and oncologists have cautioned against the high price of anticancer drugs. They argue that the current drug development model that relies on patents and short-term shareholder value is proving unsustainable, since the cost of the new generation of drugs puts many of them out of reach for the average consumer. The high price of cancer drugs is especially troubling in the context of middle- and low-income countries, where the burden of cancer carries disproportionate impact. To analyse the pricing of anticancer drugs, we examined legal controversies, regulatory treaties and documents, as well as the history of pricing data in India. We also conducted interviews with policy consultants and surveyed financial data filings of major global and Indian pharmaceutical corporations. Our research revealed that global trade agreements have become key barriers to lowering anticancer drug prices. This article argues that in the shadow of the World Trade Organization (WTO) and with Trans-Pacific Partnership (TPP) imminent, serious policy changes are necessary to ensure the survival of generic production in the market for anticancer drugs.

2005 Review of the Poverty Reduction Strategy Approach - Balancing Accountabilities and Scaling Up Results

Policy Papers ◽  
2005 ◽  
Vol 2005 (67) ◽  
Author(s):  
Keyword(s):  
World Bank ◽  
Low Income ◽  
Poverty Reduction ◽  
Scaling Up ◽  
Low Income Countries ◽  
New Approach ◽  
The World Bank ◽  
Reduction Strategies ◽  
Poverty Reduction Strategy ◽  
The International Monetary Fund

In December 1999, the World Bank (the Bank) and the International Monetary Fund (the Fund) introduced a new approach to their relations with low-income countries, centered around the development and implementation of poverty reduction strategies (PRS) by the countries as a precondition for access to debt relief and concessional financing from both institutions. These strategies were also expected to serve as a framework for better coordination of development assistance among other development partners.

scholarly journals Integrated nutrition science: from theory to practice in South Africa

2005 ◽  
Vol 8 (6a) ◽  
pp. 760-765 ◽  
Author(s):  
HH Vorster ◽  
BM Margetts ◽  
CS Venter ◽  
MP Wissing
Keyword(s):  
Low Income ◽  
Nutrition Transition ◽  
Health Behaviours ◽  
Integrated Approach ◽  
Low Income Countries ◽  
New Approach ◽  
Nutrition Science ◽  
Theory To Practice ◽  
Nutrition Research

AbstractObjectiveTo describe an integrated, holistic conceptual framework and research paradigm for a better understanding of the nutrition transition in middle- and low-income countries.MotivationCurrent inability effectively to prevent the increasing burden related to changes in food consumption patterns and other health behaviours of populations in transition motivates a new approach for nutrition research and practice. In this proposed approach, broader and integrated dimensions of science and practice may be applied for a better understanding of this complex phenomenon.ResultExamples from our own studies are given and quoted to illustrate how results from transdisciplinary studies were used to design an integrated, holistic programme to improve quality of life of people infected with HIV.ConclusionBased on these experiences it is argued that the more holistic and integrated approach should and could lead to more effective and sustainable interventions to prevent the adverse health consequences of the nutrition transition. At the same time such an approach will contribute to efforts to conserve the environment and also human, living and natural resources.

scholarly journals Barriers inhibiting effective detection and management of postpartum hemorrhage during facility-based births in Madagascar: findings from a qualitative study using a behavioral science lens

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sara V. Flanagan ◽  
Tina Razafinamanana ◽  
Charlotte Warren ◽  
Jana Smith
Keyword(s):  
Decision Making ◽  
Best Practices ◽  
Low Income ◽  
Postpartum Hemorrhage ◽  
Clinical Decision Making ◽  
Behavioral Science ◽  
Low Risk ◽  
Low Income Countries ◽  
Care Providers ◽  
Clinical Practices

Abstract Background Postpartum hemorrhage (PPH) is the leading cause of maternal mortality in low-income countries, and is the most common direct cause of maternal deaths in Madagascar. Studies in Madagascar and other low-income countries observe low provider adherence to recommended practices for PPH prevention and treatment. Our study addresses gaps in the literature by applying a behavioral science lens to identify barriers inhibiting facility-based providers’ consistent following of PPH best practices in Madagascar. Methods In June 2019, we undertook a cross-sectional qualitative research study in peri-urban and rural areas of the Vatovavy-Fitovinany region of Madagascar. We conducted 47 in-depth interviews in 19 facilities and five communities, with facility-based healthcare providers, postpartum women, medical supervisors, community health volunteers, and traditional birth attendants, and conducted thematic analysis of the transcripts. Results We identified seven key behavioral insights representing a range of factors that may contribute to delays in appropriate PPH management in these settings. Findings suggest providers’ perceived low risk of PPH may influence their compliance with best practices, subconsciously or explicitly, and lead them to undervalue the importance of PPH prevention and monitoring measures. Providers lack clear feedback on specific components of their performance, which ultimately inhibits continuous improvement of compliance with best practices. Providers demonstrate great resourcefulness while operating in a challenging context with limited equipment, supplies, and support; however, overcoming these challenges remains their foremost concern. This response to chronic scarcity is cognitively taxing and may ultimately affect clinical decision-making. Conclusions Our study reveals how perception of low risk of PPH, limited feedback on compliance with best practices and consequences of current practices, and a context of scarcity may negatively affect provider decision-making and clinical practices. Behaviorally informed interventions, designed for specific contexts that care providers operate in, can help improve quality of care and health outcomes for women in labor and childbirth.

scholarly journals A retrospective review of facility-level obstetric complications and stillbirths in southern Haiti, 2013 – 2016

2019 ◽  
Vol 43 ◽  
pp. 1
Author(s):  
Alka Dev ◽  
Keegan O’Hern ◽  
Joseph Yves Domerçant ◽  
Gerard Lucien ◽  
Lafortune Lucie ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Low Income ◽  
Postpartum Hemorrhage ◽  
Incidence Rates ◽  
Obstetric Complications ◽  
Low Income Countries ◽  
Published Data ◽  
Integrated Monitoring ◽  
Cross Sectional ◽  
High Volume Hospital

Objective. To assess the incidence of obstetric complications—eclampsia, dystocia, cesarean section, postpartum hemorrhage, and stillbirths—in hospitals in southern Haiti in 2013 – 2016 and to discuss implications for improvements to the surveillance of birth outcomes. Methods. This was a cross-sectional, retrospective study of data for 32 442 deliveries recorded in 2013 – 2016 by the Integrated Monitoring, Evaluation, and Surveillance System for facilities across three departments and one high-volume hospital in southern Haiti. Annual incidence rates of eclampsia, dystocia, cesarean section, postpartum hemorrhage, and stillbirths (both macerated and fresh) were calculated. Results. The incidence of eclampsia in the study sample was 2% – 3% and of dystocia approximately 5%, comparable to elsewhere in Haiti and other low-income countries. Cesarean delivery rates averaged about 15% annually. Postpartum hemorrhage rates were lower than published data from similar settings. Stillbirth rates ranged from 30 – 62 per 1 000 births at all facilities, higher than previously recorded by the country’s population surveys. The rates of macerated stillbirths were remarkably high, close to 50% of total stillbirths, indicating severe delays in seeking or receiving emergency obstetric care. Conclusions. This study provides important benchmarks for the current burden of preventable labor- and delivery-related complications in Haiti. Surveillance data suggest an urgent need for the management of hypertensive disorders during pregnancy, timely cesarean sections for dystocia, and management and treatment of postpartum hemorrhage in Haiti. Frequent data reviews may help address facility-specific bottlenecks.

POSTPARTUM HEMORRHAGE - PREVENTION AND MANAGEMENT

2017 ◽  
pp. 32-39
Author(s):  
Gia Dinh Nguyen
Keyword(s):  
Low Income ◽  
Postpartum Hemorrhage ◽  
Hypovolemic Shock ◽  
Low Income Countries ◽  
Obstetric Hemorrhage ◽  
Maternal Deaths ◽  
Birth Attendants ◽  
Prediction And Prevention ◽  
Life Threatening ◽  
Life Threatening Event

Most maternal deaths due to postpartum hemorrhage (PPH) occur in low-income countries in settings (both hospital and community) where there are no birth attendants or where birth attendants lack the necessary skills or equipment to prevent and manage PPH and shock. In hospital, obstetricians should try to perform the prediction and prevention of PPH, finding the risk factors for developing PPH and how can they be minimised. The treatment of patients with PPH has two major components: (1) Resuscitation and management of obstetric hemorrhage and, possibly, hypovolemic shock and (2) Indentification and management of the underlying cause(s) of the hemorrhage. Successful management of PPH requires that both components be simultaneously and systematically addressed. PPH is a potential life-threatening event. Right from the start, obstetricians have early opportunities to assess risk, anticipate, prevent, plan in advance of a PPH, and can help to improve patients outcomes Key words: postpartum hemorrhage (PPH)

scholarly journals A Microenterprise-Centered Economic Development Strategy for the Rural South: Sustaining Growth with Economic Opportunity

2000 ◽  
Vol 32 (2) ◽  
pp. 331-344
Author(s):  
Ralph D. Christy ◽  
Mark D. Wenner ◽  
Wylin Dassie
Keyword(s):  
International Development ◽  
Development Strategy ◽  
Low Income ◽  
Low Income Countries ◽  
Rural South ◽  
Basic Premise ◽  
New Approach ◽  
Economic Development Strategy ◽  
Productive Activities ◽  
Donor Agencies

Microenterprise programs (MEPs) have become an important research concern and rural development strategy in international development circles. The basic premise of this approach is that microenterprises , that is firms with fewer than 10 employees, can be provided with a series of small loans that allow them to start or expand productive activities and thereby increase incomes and escape poverty. Governments and donor agencies have expanded funding for microfinance programs in low-income countries and more articles appear in the Western media about the success of this new approach in assisting the poor.

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