1. GIRMMAHP Initiative Postpartum Hemorrhage (PPH) Working Group Meeting March 20, 2006 Albert Figueras Washington, March 20, 2006

2. Catalan acronym for: International Group for Reducing Maternal Mortality Associated to Postpartum Hemorrhage Support:

3. Participant Researchers Catalonia: Albert Figueras (Coordination) Nicaragua: Edgar Narváez Dominican Republic: Angiolina Camilo Peru: Susana Vásquez Argentina: Mabel Valsecia Guatemala: José María del Valle

4. 1.- The reasons that explain the intervention - shaming figures - overload of scientific information 2.- Logistics of the intervention 3.- Preliminar results: Nicaragua

5. 1.- The reasons that explain the intervention - shaming figures - overload of scientific information 2.- Logistics of the intervention 3.- Preliminar results: Nicaragua

6. Several figures - Nicaragua (2001): 107 deaths/100,000 live births (57% due to PPH) - Dominican R.: 150/100,000 l.b.

7. Additional LA figures: MM (2000) Bolivia 420 /100,000 l.b. Peru 410 /100,000 l.b. Brazil 260 /100,000 l.b. Guatemala 240 /100,000 l.b. Ecuador 210 /100,000 l.b. Argentina 82 /100,000 l.b.

8. Additional LA figures: MM (2000) Bolivia 420 /100,000 l.b. Peru 410 /100,000 l.b. Brazil 260 /100,000 l.b. Guatemala 240 /100,000 l.b. Ecuador 210 /100,000 l.b. Argentina 82 /100,000 l.b. Italy 5 /100,000 l.b. Spain 4 /100,000 l.b.

9. Maternal mortality is an indicator of social and economic inequity

10. PPH prevention: identification of risk factors - pregnancy - intra-partum active managing of 3rd stage - uterotonics (oxitocyn,...) - controlled cord traction - uterine massage after delivery of the placenta - periodic control of constants

11. PPH Managing: - appropriate causal diagnosis - uterine atonia / bleeding - vaginal lesions - coagulation disorders - general support measures

12. It does exist sufficient and appropriate high-quality scientific information on how to prevent PPH

13. Why mortality due to PPH is so high in so many countries? It does exist sufficient and appropriate high-quality scientific information on how to prevent PPH...

14. Access to health system Quality of care Risk factors identification Pregnancy controls Knowledge Medicines Information Why mortality due to PPH is so high in so many countries?

15. Participating in network means: - more efficiency than individual work - preservation of individualities

17. 1.- The reasons that explain the intervention - shaming figures - overload of scientific information 2.- Logistics of the intervention 3.- Preliminar results: Nicaragua

18. Scientific information and information about medicines

20. rational medicines prescription and use (also valid for medicines, medical devices, procedures...) appropriate medicine for the patient who need it at the appropriate dosage and duration giving enough information about how to use it to the patient

21. colleages routine obsolescence patients place: public / private reps.

22. - information today - medicines and practice information today - Evidence-Based Medicine (use and abuse)

23. recommended “daily dose” of reading scientific papers in order to be appropriately updated (or to avoid obsolescence) in one’s own speciality: 17 papers / day M. Rawlins. UK’s NICE Chairman

24. Consequences - therapeutic failure - obsolete practices - low quality care - innecessary waste of resources... without being conscious of this

25. How to measure the quality of real practice? Drug utilization studies (DUS) (audit studies, observational studies) - easy to do - statistically simple - cheap - quick

26. initial situation hypothesis DUS intervention results, impact ?

27. Clinical guidelines why adherence is low?

28. 1.- The reasons that explain the intervention - shaming figures - overload of scientific information 2.- Logistics of the intervention 3.- Preliminar results: Nicaragua

29. http://www.girmmahp.net

34. Farmacología Medicina- UNNE

38. 1.- The reasons that explain the intervention - shaming figures - overload of scientific information 2.- Logistics of the intervention 3.- Preliminary results: Nicaragua