Authors: Crowther M, Dyer RA, Bishop DG, et al.
Anesthesia & Analgesia 141(3): 456-463, September 2025. doi:10.1213/ANE.0000000000007192
This cross-sectional survey evaluated hospital readiness to manage hemorrhage during and after cesarean delivery across 29 African countries. Data from 140 hospitals highlighted gaps in implementing WHO recommendations for postpartum hemorrhage (PPH) prevention and treatment. Oxytocin was widely available (93.5%), but access to misoprostol (73.2%), ergometrine (25.9%), and heat-stable carbetocin (8.7%) was inconsistent. While most hospitals practiced controlled cord traction (98.5%) and had crystalloid fluids (95.7%), availability of tranexamic acid (69.8%) and intrauterine balloon tamponade devices was limited. Blood access varied, with emergency blood available in 73.4% of hospitals, but platelets (23.2%), cryoprecipitate (15.2%), and fibrinogen (7.9%) were scarce. Most facilities had treatment protocols (83.1%) and immediate access to theaters (90.6%), but referral systems, simulation training, and specialist cover after-hours were lacking.
What You Should Know:
Despite widespread access to oxytocin and intravenous fluids, many African hospitals lack reliable availability of key uterotonics, tranexamic acid, blood components, and simulation-based training. These deficiencies leave women at high risk of death from postpartum hemorrhage following cesarean delivery. System-level improvements in drug supply, blood banking, and staff readiness are urgently needed.
KEY POINTS
- Question: Are hospitals in Africa equipped to implement the recommendations by the World Health Organization (WHO) to prevent and treat hemorrhage during and after cesarean delivery (CD)?
- Findings: Hospitals across Africa do not implement simple preventative, therapeutic, and organizational measures to prevent and treat postpartum hemorrhage (PPH) during and after CD, are unable to manage massive obstetric hemorrhage, and lack skilled human resources.
- Meaning: The survey has identified quality improvement targets to reduce PPH during and after CD in Africa.
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