Postpartum hemorrhage (PPH) is blood loss greater than 500 ml within 24 hours after delivery. This condition accounts for approximately 125,000 deaths per year and 35% of all maternal deaths. Uterine atony, retained placenta, inverted or ruptured uterus, cervical, vaginal, or perineal lacerations are all common causes of PPH. Uterine atony is the primary target of uterotonic drugs though it also helps with delivery of the placenta and other uterine bleeding. Untreated, PPH can lead to shock and death within hours.
Mechanism of Action
Oxytocics, prostaglandin analogues, and ergot derivatives are the most common uterotonic agents. All produce the rhythmic uterine contractions characteristic of labor. These contractions help deliver the placenta during the third stage of labor and additionally help slow the bleeding of the uterus.
Uterotonics require injection after the delivery of the baby as part of the active management of the third stage of labor. Oxytocin and ergometrine must be refrigerated at 2- 8°C, though some versions can spend up to three months in room temperature conditions.
Current use in High-Resource settings
Oxytocin and its synthetic equivalents (e.g. Pitocin, Syntocinon) are routinely administered to prevent PPH. Preventative dosing is typically 10 IU intramuscularly for the active management of the third stage of labor. Oxytocin is available on a generic basis at relatively low cost and is commonly used to slow bleeding after birth.
Application in Low-Resource settings
Where refrigeration and a skilled attendant are available, oxytocin is the drug of choice for the prevention of PPH. Packaging oxytocin in the Uniject system has been demonstrated to improve its correct use. In home settings, where refrigeration and means of injection are less common, misoprostol is more viable. Several studies have shown that minimally trained attendants have the ability to successfully administer therapeutic doses. A growing body of literature add credibility to misoprostol’s proponents who believe it is the single most promising technology to reduce maternal mortality due to PPH in the home setting. Where registered for specific obstetric and gynecologic indications, misoprostol can be procured as a generic for less than $0.14 per 200 mcg tablet.
Related Technologies in Development
Dry Powder Oxytocin, Ergometrine, Oxytocin Uniject Device, Prostoglandin F2a