CEU: Prevention and Treatment of Postpartum Hemorrhage: New Advances for Low-Resource Settings


  • Suellen Miller CNM, PhD,

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    • Suellen Miller, RN, CNM, MHA, PhD, is Director of Safe Motherhood Programs, the Women's Global Health Imperative, University of California, San Francisco, Department of Obstetrics, Gynecology, and Reproductive Sciences, and Adjunct Assistant Professor, University of California, Berkeley, School of Public Health, Maternal and Child Health Program. Dr. Miller is researching postpartum hemorrhage prevention and treatment in Egypt, Nigeria, Mexico, and Tibet.

  • Felicia Lester MPH, MS,

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    • Felicia Lester is a student in the UCB/UCSF Joint Medical Program through which she received an MPH in Maternal and Child Health and an MS in Health and Medical Sciences. She is currently doing clinical rotations at UCSF and will receive her MD in 2005.

  • Paul Hensleigh MD, PhD

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    • Paul Hensleigh, MD, PhD, served on the faculty of the Stanford University Medical School, Department of Gynecology and Obstetrics from 1977 to 2000. During this time he also was Chief of Obstetrics at the Santa Clara Valley Medical Center, San Jose, California. Since his early retirement he has worked in Pakistan, Macedonia, Albania, Mexico, Nigeria, and South Korea.

Women's Global Health Imperative, University of California, San Francisco, Box 0886, San Francisco, CA 94105-3444. E-mail: smiller@psg.ucsf.edu


Postpartum hemorrhage due to uterine atony is the primary direct cause of maternal mortality globally. Management strategies in developed countries involve crystalloid fluid replacement, blood transfusions, and surgery. These definitive therapies are often not accessible in developing countries. Long transports from home or primary health care facilities, a dearth of skilled providers, and lack of intravenous fluids and/or a safe blood supply often create long delays in instituting appropriate treatment. We review the evidence for active management of third-stage labor and for the use of specific uterotonics. New strategies to prevent and manage postpartum hemorrhage in developing countries, such as community-based use of misoprostol, oxytocin in the Uniject delivery system, the non-inflatable antishock garment to stabilize and resuscitate hypovolemic shock, and the balloon condom catheter to treat intractable uterine bleeding are reviewed. New directions for clinical and operations research are suggested.