Aimagambetova Gulzhanat, Bapayeva Gauri, Sakhipova Gulnara, Terzic Milan
Department of Surgery, School of Medicine, Nazarbayev University, Astana 010000, Kazakhstan.
Clinical Academic Department of Women's Health, CF "University Medical Center", Astana 010000, Kazakhstan.
J Clin Med. 2024 Dec 4;13(23):7387. doi: 10.3390/jcm13237387.
Postpartum hemorrhage (PPH) represents a critical emergency condition and the principal cause of maternal morbidity and mortality worldwide. It encompasses excessive bleeding following childbirth, which can arise from various causes. Prompt recognition and management are essential to mitigate severe outcomes and ensure maternal safety. The incidence of PPH in low- and middle-income countries (LMICs) is higher than in developed countries. Healthcare systems in developing countries face multiple challenges that may impact PPH management at policy, facility, and community levels. The mentioned barriers could be addressed by providing an empowering environment via the implementation of supportive policies, access to PPH care, planning supplies, allying strategies, providing training, and utilization of guidelines and algorithms for PPH management. Evidence-based international guidelines should serve as an integral part of appropriate management. On the other hand, LMICs have limited opportunities to implement the proposed international algorithms and guidelines. Therefore, some amendments based on the resource/expertise availability should be considered at the specific clinical site. This review summarizes and updates the accumulated knowledge on postpartum hemorrhage, focusing on challenging management options in developing countries. In many LMICs, maternal morbidity and mortality linked to PPH were improved after the implementation of standardized protocols and timely and purposeful interventions. International support in healthcare professionals' training, enhancing resources, and the provision of an adapted evidence-based approach could assist in improving the management of PPH in LMICs. Refining our understanding of specific local circumstances, international support in specialists' training, and the provision of evidence-based approaches may assist in improving the management of PPH in LMICs and contribute to safer childbirth.
产后出血（PPH）是一种危急的紧急情况，也是全球孕产妇发病和死亡的主要原因。它包括分娩后出现的大量出血，其原因可能多种多样。及时识别和处理对于减轻严重后果和确保孕产妇安全至关重要。低收入和中等收入国家（LMICs）的产后出血发生率高于发达国家。发展中国家的医疗系统面临多重挑战，这些挑战可能在政策、机构和社区层面影响产后出血的管理。通过实施支持性政策、提供产后出血护理、规划物资供应、联合策略、提供培训以及利用产后出血管理指南和算法来营造有利环境，可以克服上述障碍。基于证据的国际指南应成为适当管理的一个组成部分。另一方面，低收入和中等收入国家实施拟议的国际算法和指南的机会有限。因此，应根据特定临床场所的资源/专业知识可用性考虑一些修订。本综述总结并更新了关于产后出血的累积知识，重点关注发展中国家具有挑战性的管理方案。在许多低收入和中等收入国家，实施标准化方案以及及时且有针对性的干预措施后，与产后出血相关的孕产妇发病率和死亡率有所改善。在医疗专业人员培训方面提供国际支持、增加资源以及提供适配的循证方法，有助于改善低收入和中等收入国家产后出血的管理。深化我们对具体当地情况的理解、在专家培训方面提供国际支持以及提供循证方法，可能有助于改善低收入和中等收入国家产后出血的管理，并有助于实现更安全的分娩。
