This kit has been developed to support the provision of a Sexual and Reproductive Health service at the primary healthcare facility level (BEmONC). 

It contains pharmaceuticals that can be used during the provision of postpartum care to individuals in the third stage of labour (i.e., the period following a baby's birth but prior to the completed delivery of the placenta) in order to help reduce the risk of postpartum haemorrhage. 

This kit can also be used by health professionals in their treatment of individuals experiencing postpartum haemorrhage.

Use in Maternal Health

Postpartum haemorrhage remains a significant cause of maternal morbidity and mortality; it accounts for nearly one quarter of all maternal deaths globally and continues to be the leading cause of maternal mortality in most low-income countries (WHO, 2018). 

It is therefore vital that in acute humanitarian/ emergency contexts, health providers continue to offer services and care that specifically target the prevention and treatment of postpartum complications (IAWG, 2018). 

WHO (2018) recommends the use of an effective uterotonic medication in the third stage of labour during all births, as a preventative measure against the risk of postpartum haemorrhage. This type of medication can also be used in the first-line management of postpartum haemorrhage should it occur.

Oxytocin is the recommended uterotonic for the prevention of postpartum haemorrhage however it requires specialised storage and transportation and can only be administered by skilled personnel (IAWG, 2018). 

Misoprostol is another uterotonic medication that can be used by Sexual and Reproductive Health service providers in settings where the administration of Oxytocin is not possible (e.g., due to the lack of cold-chain infrastructure, suitable healthcare facilities and/or skilled birth attendants) (WHO, 2018).  

Due to being in a tablet form that does not require specialised storage, Misoprostol can also be safely self-administered by individuals who have delivered their babies at home such as in the case of unattended home births in humanitarian and/ or remote contexts (Mir et al., 2012; Vallely et al., 2016; IAWG, 2018). 

As the guidance on the safe and appropriate administration of Misoprostol is determined by the specific clinical reason for and context of its use, there are three different Misoprostol Sexual and Reproductive Health kits available on this platform. For details of the other Misoprostol kits please see: Misoprostol Distribution Kit, Complementary to Basic Clean Delivery Kit and Misoprostol, Abortion Care Kit.

This specific kit has been designed to be used in conjunction with the Clinical delivery assistance, Midwifery supplies, Drugs and Disposable Equipment Kit. It is intended for the use of trained health personnel in the active management of the third stage of labour and as first-line treatment of postpartum haemorrhage in settings where the use of Oxytocin is not feasible. 

Context of use

This kit is intended for use within a BEmONC-level health centre or hospital clinical setting.

Adapted from UN Population Fund (UNFPA) guidance, this kit is a complementary kit to the Primary Healthcare Facility Level (BEmONC) Emergency Reproductive Health kit series (UNFPA, 2019). 

Together these kits have been designed to expediate the provision of vital Sexual and Reproductive Health care in acute humanitarian settings, primarily within Low- and Middle-income countries. They may also be useful to services addressing community healthcare needs in higher income countries during certain circumstances (e.g. natural disasters). 

Scaling

This kit has been designed to assist in the provision of a BEmONC service for a population of 30,000 people over a 3-month period. 

This expected duration is based on the assumption of a crude birth rate (CBR) of 4% and a resulting 300 deliveries occurring within this 3-month period. 

This kit has been designed according to an estimation of 15% of these expected deliveries (45 in total) occurring within the health facility. If the affected population has a higher rate of facility delivery or CBR, extra supplies may be needed to support these deliveries.

A rapid assessment of the local situation is advised to confirm the need for reproductive health kits prior to kit procurement. This will include a review of existing healthcare resources and health facility capacity as well as an assessment of the expected health needs specific to the target population. If possible, this assessment should utilize available pre-crisis demographic and services data.

Sources:

Inter-Agency Emergency Reproductive Health Kits for Use in Humanitarian Settings, 6th edition (UNFPA, 2019, p.61-63) 

WHO recommendations Uterotonics for the prevention of postpartum haemorrhage. (WHO, 2018)

Inter-Agency Fieldwork Manual on Reproductive Health in Humanitarian Settings (IAWG, 2018).

Helping rural women in Pakistan to prevent postpartum hemorrhage: a quasi experimental study. BMC Pregnancy Childbirth. (Mir et al., 2012)

Feasibility and acceptability of clean birth kits containing misoprostol for self-administration to prevent postpartum hemorrhage in rural Papua New Guinea. International Journal of Gynecology & Obstetrics. (Vallely et al.,2016)

Solution creators

This solution was developed by Stevie-Jade Beeby with contributions from Paula Przybylowicz Vidal and Anuradha Dissanayake.