Gynuity Health Projects, New York, NY 10010, USA.
Int J Gynaecol Obstet. 2012 Dec;119(3):210-2. doi: 10.1016/j.ijgo.2012.08.005. Epub 2012 Sep 12.
Excessive postpartum hemorrhage (PPH) is a leading cause of maternal death globally. Current approaches to address PPH at the community level focus on reducing the incidence of PPH, but often fail to address the issue of PPH treatment. Given that institutional delivery is not yet a reality for all women, comprehensive care for excessive bleeding after delivery needs to be available at the community level. A new hybrid model of "secondary prevention"-presumptive treatment for women with more than average blood loss-presents one alternative community-based approach. If shown to be effective and feasible, this approach could support policy changes and avoid the need to provide uterotonics to all women after delivery. This Special Communication discusses some of the benefits and limitations of current community approaches using misoprostol for PPH prevention and explains why it is now opportune to translate clinical knowledge into pragmatic PPH service delivery strategies.
产后出血过多（PPH）是全球范围内导致产妇死亡的主要原因。目前在社区层面解决 PPH 的方法侧重于降低 PPH 的发生率，但往往未能解决 PPH 治疗的问题。鉴于并非所有妇女都能实现住院分娩，因此需要在社区一级提供产后大出血的综合护理。“二级预防”的新模式——对失血过多的妇女进行推测性治疗——为基于社区的方法提供了一种替代方案。如果证明这种方法有效且可行，那么它可以支持政策的改变，避免在产后为所有妇女提供宫缩剂。本专题通讯讨论了目前使用米索前列醇预防 PPH 的社区方法的一些益处和局限性，并解释了为什么现在将临床知识转化为实用的 PPH 服务提供策略是适时的。
