Second global call for data on postpartum haemorrhage
Postpartum Haemorrhage (PPH) affects millions of women every year and accounts for over 20% of all maternal deaths reported globally. The Second Global Call from the World Health Organisation is out to develop a robust evidence base for the definition of postpartum Haemorrhage (PPH). How much blood loss is too much and when do we define PPH to promote early intervention. There is substantial disagreement on several domains, including the amount of blood loss, time of measurement, inclusion of clinical signs and symptoms of haemodynamic instability, and mode of delivery.
As the requirement for surgical intervention and blood transfusions increases exponentially when blood loss hits critical levels this work will be invaluable to help define new thresholds for conservative and refractory PPH management.
Background
Postpartum haemorrhage (PPH), commonly defined as a blood loss of 500 ml or more within 24 hours after birth1, is the leading cause of maternal mortality worldwide. It affects millions of women every year and accounts for over 20% of all maternal deaths reported globally.2,3 Death from PPH is largely preventable and has been significantly reduced in high-income countries (HICs). Yet women in low- and middle-income countries (LMICs) continue to be disproportionately affected. The vast majority (>80%) of maternal deaths from PPH occur in sub-Saharan Africa and south Asia. 2
While the 500 ml threshold is the most internationally accepted definition, the evidence base is unclear. Recent reports on the definitions of PPH in reputable normative guidelines show substantial disagreement on several domains, including the amount of blood loss, time of measurement, inclusion of clinical signs and symptoms of haemodynamic instability, and mode of delivery (whether PPH in vaginal births and caesarean section should be separately defined).4
To address this critical gap, the World Health Organization (WHO) has initiated a rigorous process to reappraise the current definitions of PPH and consider refinement (or revisions) to improve outcomes of PPH care globally. The WHO aims to achieve this goal by embarking on a multi-step process that includes syntheses and review of up-to-date research evidence base underpinning the definitions of PPH and reach scientific consensus through external technical consultations. As an important step to achieving this objective, WHO is seeking the cooperation and contributions of researchers and research institutions with reliable data from PPH studies.
Purpose
To develop a robust, evidence base for the definition(s) of PPH, WHO is gathering data on PPH from various sources (i.e., published and unpublished studies and routine/administrative systems) from different contexts and geographical regions.
How to apply
The data to be shared for this project must meet study-level eligibility criteria to be included in the pooled database. As a first step, the principal investigator (PI) interested in sharing the data must complete an online form to facilitate the verification of whether the study meets the eligibility criteria at the study-level.
After the PI’s completion of the online form, WHO will review the submitted material and contact the PI responsible for informing about the eligibility status of the data. For eligible studies, WHO will invite PIs/institutions to share any data sharing agreement they might have with WHO. In the absence of such agreement, WHO will provide a standard data-sharing agreement as a starting point towards a version both parties will agree to. After both parties sign the agreement, the study PI can proceed with sharing the data.
The acquired de-identified data will be stored in a secure repository created by WHO specifically for this project. The management and updates of the repository will be the sole and exclusive responsibility of WHO and PIs collaborating with it will have access only to their own raw data. The shared data will be used only to achieve the objectives of this project.
For reference, we kindly ask you to review the following documentation:
- Concept note of the global call for data
- Data Sharing Standards (DSS), including a data sharing process
It is important for PIs to be familiarized with the information included in the documents listed above, in case their data are eligible for this project. Please note that for those cases where the PI’s institution does not have a data sharing agreement, WHO will facilitate this process by sharing key principles for data sharing which can then be used as a template for a data sharing agreement.
If you have any question, please contact us at PPHDefinitionProject@who.int with the following email subject "Questions – Global call for data on postpartum haemorrhage".
Deadline for submission: 20-Sept-2024