Prevention of Postpartum Hemorrhage: Options for Home Births in Rural Ethiopia
), A. Gessessew(2), A. K. Abraha(3), M. Holston(4), M. Potts(5),
(1)
(2)
(3)
(4)
(5)
Corresponding Author
Abstract
This paper sought to determine the safety and feasibility of home-based prophylaxis of postpartum hemorrhage (PPH) with misoprostol, including assessment of the need for referrals and additional interventions. In rural Tigray, Ethiopia, traditional birth attendants (TBAs) in intervention areas were trained to administer 600mcg of oral misoprostol. In non-intervention areas women were referred to the nearest health facility. Of the 966 vaginal deliveries attended by TBAs, only 8.9% of those who took misoprostol prophylactically (n=485) needed additional intervention due to excessive bleeding compared to 18.9% of those who did not take misoprostol (n=481).The experience of symptoms among those who used misoprostol can be considered of minor relevance and self-contained. This study found that prophylactic use of misoprostol in home births is a safe and feasible intervention. Community health care workers trained in its use can correctly and effectively administer misoprostol and be a champion in reducing PPH morbidity and mortality (Afr J Reprod Health 2009; 13[2]:87-95).
RĖSUMĖ
La prévention de l’hémorragie du post-partum: options pour les naissances à domicile en Ethiopie rurale. Cette étude avait pour objectif de déterminer la sauveté et la faisabilité de la prophylaxie adaptée localement de l’hémorragie du post-partum (PHP) à l’aide de misoprostol, y compris l’évaluation de la nécessité des orientations vers les spécialistes et des interventions supplémentaires. A Tigray, en Ethiope, les sages-femmes traditionnelles (SFT) dans les régions de l’intervention ont été formées pour administrer 600 mcg de misoprostol par voie orale. Dans les régions où il n’y pas d’intervention, on a orienté les femmes vers un établissement de santé le plus proche. Sur les 996 accouchements par voie vaginale que les SFT ont fait accoucher, seul 8,9% de celles qui ont pris misoprostol prophylactiquement (n=485) avaient besoin d’une intervention supplémentaire à cause de l’hémorragie excessive par rapport à 18,9% de celles qui n’ont pas pris misoprostol (n=481). L’expérience de celles qui ont pris misoprostol ne peut pas être considérée come étant d’une pertinence mineure ou autonome. Cette étude a découvert que l’emploi prophylactique de misoprostol dans les accouchements à domicile est une intervention sans danger et faisable. Les membres du personnel soignant de la communauté qui ont été formés de la manière de l’employer, peuvent administrer misoprostol effectivement et de bonne manière et peuvent être des champions dans la réduction de la morbidité et la mortalité de la PHP (Afr J Reprod Health 2009; 13[2]:87-95).
KEYWORDS: Misoprostol; postpartum hemorrhage; traditional birth attendants (TBAs)
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