Pathway to Implementation of Pre-eclampsia/Eclampsia Management at Scale and Pathway to Implementation of Postpartum Hemorrhage Prevention and Management at Scale

The country's main causes of maternal death are postpartum hemorrhage (PPH), eclampsia/pre-eclampsia (PE/E), and infections. Basic emergency obstetric and newborn care (EmoNC) services are available at 0.1% of health centers, while comprehensive EmoNC services are available at 0.5% of health centers. In 2010, 385 out of 2,161 health centers had agents trained in EmoNC. The country has a promising context for improving maternal health, with a national policy on reproductive health, an active Safe Motherhood program, and partnerships with international organizations such as WHO, UNFPA, and USAID. Implementing NGOs, including MSI and SAF FJKM, are also involved in EmoNC activities. A small PPH prevention and management project is being implemented by ASGOB/ACCESS in ten health centers in Antananarivo City. Operational research on the use of misoprostol and syntocinon for postpartum hemorrhage prevention and management has been conducted by Marie Stopes International (MSI). The study compared the effectiveness of these two medications at the community health center level and in MSI's clinics. The Essential Drug List for Madagascar includes oxytocin, misoprostol, magnesium sulfate (MgSO4), diazepam, labetalol, hydralazine, nifedipine, and methyldopa. Midwives have the authority to diagnose severe PE/E and administer initial MgSO4 doses at the lowest level facility where they work. The country is working towards the implementation of pre-eclampsia/eclampsia management and postpartum hemorrhage prevention and management at scale. The Africa Regional Meeting on Interventions for Impact in Essential Obstetric and Newborn Care was held in Addis Ababa, Ethiopia, from February 21-25, 2011. The meeting aimed to improve the management of PE/E cases and reduce maternal and perinatal mortality. The drugs used for the prevention of postpartum hemorrhage are oxytocin and ergometrine, while misoprostol is not yet registered for reproductive health uses. Pre-service education for all skilled birth attendants (SBAs) includes active management of the third stage of labor (AMTSL), and in-service training for SBAs also includes AMTSL. The broader EmoNC program includes both PE/E and PPH prevention and management, and pre-service education for SBAs includes current global management principles for PE/E.