By The PPH Foundation

Preventing postpartum haemorrhage, or PPH, begins long before childbirth. It requires a combination of skilled care, timely use of effective medicines, and readiness at every level of the health system. The World Health Organization identifies prevention as one of the most cost-effective strategies for reducing maternal deaths globally, particularly in low-resource settings such as many parts of Kenya, where simple, well-applied interventions can save thousands of lives.

According to Prof Moses Obimbo Madadi, the e-PPH Initiative Project Lead, prevention starts with proper management of the third stage of labour. Active management, which includes giving a prophylactic uterotonic immediately after the baby is born and safely delivering the placenta, remains the single most effective step in preventing heavy bleeding. He emphasises that “routine readiness to measure and respond to bleeding, rather than waiting for it to worsen, is the key to saving lives.”

While oxytocin remains the first-choice uterotonic in many hospitals, its dependency on refrigeration presents challenges in rural facilities. To address this, WHO and FIGO now recommend heat-stable carbetocin as an effective alternative for preventing PPH where maintaining a cold chain is difficult. The medicine retains potency at room temperature, requires no refrigeration, and provides prolonged uterine contraction. Several counties in Kenya, including Makueni and Kakamega, are now piloting its use, with early results showing improved maternal outcomes.

However, introducing better medicines must go hand in hand with training and supervision. Dr Frederick Kireki Omanwa, Consultant Obstetrician and Gynaecologist and President of the Kenya Obstetrical and Gynaecological Society, notes that training remains central to impact. “Every midwife and clinician must not only know what to give, but when and how to give it,” he says. Simulation-based learning, emergency drills, and mentorship ensure that the right actions happen at the right time.

Accurate detection of blood loss is another cornerstone of prevention. Visual estimates alone are unreliable and often understate true blood loss. WHO now recommends objective measurement using calibrated blood-collection drapes or similar devices. These low-cost tools enable early detection and timely intervention. Kenya has begun scaling up their use under the Ministry of Health’s Maternal and Newborn Health Roadmap 2023–2027, with promising results in county referral hospitals.

Prevention also requires functional systems, dependable supply chains, reliable blood availability, and clear clinical protocols. Local initiatives like the Roaming Blood  and county rollouts of heat-stable carbetocin show how supply, technology, and community engagement can reinforce clinical readiness. Integrating these with continuous monitoring ensures that emergency supplies are always within reach.

Finally, WHO now advocates for an integrated care bundle approach, where preventive and emergency measures coexist in readiness. This includes the routine use of uterotonics, early blood loss measurement, rapid access to tranexamic acid, and mechanical or surgical backup when needed. As Prof Obimbo underscores, “Prevention is not just about medicine; it’s about systems that work. With the right tools, training, and teamwork, postpartum haemorrhage can be entirely preventable.”

Photo by Mikhail Nilov: https://www.pexels.com/photo/woman-in-white-shirt-lying-on-bed-6932087/

Sources
• World Health Organization, WHO Recommendations on the Assessment of Postpartum Blood Loss and Use of a Treatment Bundle for Postpartum Haemorrhage, 2023
• FIGO, Guidance on the Use of Heat-Stable Carbetocin as an Alternative to Oxytocin, 2023
• Gavi, Global Supply and Introduction Notes for Heat-Stable Carbetocin, 2023
• Kenya Ministry of Health, Maternal and Newborn Health Roadmap 2023–2027
• Makueni County Program Report on the Introduction of Heat-Stable Carbetocin and the PPH Prevention Package, 2024