In more developed countries, management strategies involve
crystalloid fluid replacement, blood transfusions, and
surgery—definitive therapies best delivered in wellequipped
and staffed facilities. In many primary care
facilities there are no personnel trained to perform intravenous
(IV) placement, even if IV fluids are available. Blood
transfusion ability may be limited to the biggest city
hospitals, and even there availability of safe blood is
limited. Even the simplest therapies, such as fundal massage
and intramuscular (IM) and/or IV oxytocin administration,
are outside the training and skills of many birth
attendants, if a birth attendant is present.
Health care providers involved in the Safe Motherhood
Initiative,9 ICM, FIGO, and other organizations devoted to
making birth safer for women in all countries are looking to
new strategies, techniques, technologies, and adaptations of
underused technologies to reduce maternal mortality attributable
to postpartum hemorrhage. As reported recently in
the Lancet, there are several promising technologies for
treatment of postpartum hemorrhage that are relatively
simple, which can be used by personnel with limited skills
and training and can be available in remote and/or rural
areas of less developed countries.8 These include 1) universal
use of active management of third-stage labor, 2)
oxytocin in Uniject (BD Pharmaceutical Systems) as a way
of overcoming some of the barriers to oxytocin use in
low-resource settings, 3) the use of oral and/or rectal
misoprostol for prevention and treatment of postpartum
hemorrhage, 4) the non-inflatable antishock garment
(NI-ASG) for stabilization and resuscitation of hypovolemic
shock secondary to postpartum hemorrhage, and 4) the
hydrostatic condom balloon catheter to control intractable
postpartum hemorrhage secondary to uterine atony