HRP – celebrating 40 years of innovation
For 40 years, HRP – The UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction – has been the main instrument within the United Nations system for research in human reproduction, bringing together policy-makers, scientists, health care providers, clinicians, consumers and community representatives to identify and address priorities for research to improve sexual and reproductive health.
HRP at 40 – Among key achievements
During 2012, each month we will highlight a key achievement of HRP in its efforts to achieve universal access to reproductive health.
Reducing maternal deaths by preventing postpartum haemorrhage
Postpartum haemorrhage is one of the most important causes of maternal mortality accounting for at least 25% of the maternal deaths occurring each year. HRP is currently finalizing a multicountry survey in 26 countries to establish the causes and prevalence of severe morbidity and near-miss morbidity as a proxy for maternal death.
HRP conducted a large multicentre randomized trial that showed that oxytocin is the drug of choice for prevention of postpartum haemorrhage. HRP is collaborating with external partners to evaluate the safety and efficacy of misoprostol for prevention and early treatment of postpartum haemorrhage in settings where oxytocin is not available. HRP is also collaborating with the Safe Motherhood Program, University of California, San Francisco, on a randomized trial testing the effectiveness of an antishock garment to reduce maternal mortality in women with postpartum haemorrhage.
External Evaluation of HRP, 1990–2002
Between 2009 and 2010, HRP conducted a large multicentre randomized trial to determine the best way to manage the third stage of labour with the objective of reducing the risk of postpartum haemorrhage. It has been shown that a strategy of active management of third stage of labour (AMTSL) significantly reduces the risk of developing postpartum haemorrhage. However, it has been difficult to implement this strategy due to the special training needs to apply one of its components (controlled cord traction). The HRP study, in which more than 24 000 women participated, showed that omitting controlled cord traction has little effect on the risk of severe bleeding and indicates that effective prevention of postpartum haemorrhage could be accomplished with just a uterotonic agent (primarily oxytocin). The study findings have important implications for expanding access to effective care and could have a substantial impact on maternal survival in places where access to skilled medical staff is difficult.
Due to emerging new evidence, WHO is currently updating its evidence-based recommendations for prevention of postpartum haemorrhage and management of postpartum haemorrhage and retained placenta. Thirty-five questions on interventions and a list of possible outcomes in the treatment of atonic postpartum haemorrhage and retained placenta were identified by HRP and partners; these questions required 45 recommendations. The editorial base of the Cochrane Pregnancy and Childbirth Group designed and ran search strategies and carried out the initial screening of results and coordinated the production of relevant Cochrane reviews. Centro Rosarino de Estudios Perinatales (CREP) a WHO Collaborating Centre in Argentina, prepared GRADE tables and helped to update Cochrane reviews if needed. As a result of this close collaboration, within 12 months, 22 Cochrane reviews were conducted or updated for the guideline. Of these 11 are already published in The Cochrane Library and four are in the editorial process. The updated guideline will be published in the second half of 2012.