Strategies for the Management of Postpartum Hemorrhage in Low-Resource Settings: A Scoping Review

Background:Postpartum hemorrhage (PPH) remains a leading cause of maternal mortality globally, disproportionately affecting low- and middle-income countries (LMICs) due to high maternal anemia rates, skilled attendant shortages, fragile cold chains, and delayed emergency referrals [۱–۴]. This review systematically mapped evidence-based strategies for early detection, first-line management, stabilization, referral, and health system strengthening in resource-limited settings.Methods:Guided by Arksey and O’Malley’s framework and PRISMA-ScR guidelines [۵,۶], PubMed, Scopus, Web of Science, Cochrane Library, and WHO repositories were searched through August ۲۰۲۶. Keywords included postpartum haemorrhage, low-resource settings, tranexamic acid, uterotonics, uterine balloon tamponade, non-pneumatic anti-shock garment, and E-MOTIVE. LMIC-focused guidelines, randomized controlled trials, and implementation studies were screened and extracted descriptively.Results:Fourteen eligible sources established four pivotal domains:۱. Objective blood loss quantification via calibrated drapes combined with simultaneous initiation of the E-MOTIVE care bundle;۲. Prompt administration of first-line uterotonics (oxytocin, or misoprostol where cold chains fail) alongside tranexamic acid within three hours;۳. Intrauterine balloon tamponade (UBT), including low-cost condom-catheter assemblies, for atony refractory to medical therapy; and۴. Hemodynamic stabilization and transfer facilitation using the non-pneumatic anti-shock garment (NASG) [۷–۱۳].The E-MOTIVE trial demonstrated significant reductions in the composite outcome of severe bleeding, laparotomy, or maternal death [۷]. However, UBT and NASG efficacy strictly depended on structured provider training, close monitoring, and timely surgical and referral access [۱۱–۱۴].Conclusion:Effective PPH management in LMICs demands an integrated, time-critical care bundle rather than piecemeal interventions. Priorities include objective early detection, concurrent protocol execution, reliable pharmaceutical supply, simulation training, and functional referral networks. Context-appropriate solutions—such as misoprostol, low-cost UBT, and NASG—substantially reduce clinical delays and geographic inequities when embedded in responsive obstetric systems. Future research should emphasize cost-effectiveness, supply chain sustainability, and tailored local implementation models.

کلیدواژه ها:

Postpartum Hemorrhage ، Low-Resource Settings ، Maternal Mortality ، Emergency Obstetric Care