Multi-country implementation pilots on safe and appropriate use of post-partum haemorrhage medicines 

Background

Postpartum haemorrhage (PPH), defined as a blood loss of 500 ml or more, is the leading cause of maternal death worldwide, accounting for about a quarter of all maternal deaths. The majority of PPH-associated deaths can be prevented by use of uterotonics during the third stage of labour, combined with prompt and appropriate identification and management of PPH. Heat-stable Carbetocin (HSC) is a long-acting uterotonic that has similar efficacy to oxytocin in active management of third stage of labour (AMTSL) [1]. It is stable up to three years without refrigeration and therefore holds promise for use in countries with cold-chain challenges [2]. Tranexamic Acid (TXA) inhibits plasminogen activation and reduces bleeding by inhibiting the breakdown of fibrinogen and fibrinogen clots. WHO has recommendations on use of HSC for prevention when the quality of oxytocin cannot be guaranteed, and TXA for treatment [3,4]. HSC and TXA are not yet widely used in many African countries – there is variability in whether these drugs are registered or included in the essential medicines list for different countries. Introduction of HSC and TXA have the potential to improve