Dissemination and implementation of the recommendation is to be considered by all actors involved in the provision of care for pregnant women at the international, national and local levels. There is a vital need to increase access and strengthen the capacity of health centres to provide high quality services for all women giving birth. It is therefore crucial that this recommendation is translated into PPH treatment packages and programmes at country and health-facility levels.
Recommendation dissemination and evaluation
The recommendation will be disseminated through WHO regional and country offices, ministries of health, professional organizations, WHO collaborating centres, other United Nations agencies and nongovernmental organizations, among others. This recommendation will be also available on the WHO website and in the WHO Reproductive Health Library. To increase awareness of the recommendation, a short commentary will be published in a peer-reviewed journal. The recommendation will be also disseminated during meetings or scientific conferences attended by WHO staff. The executive summary will be translated into the six UN languages and disseminated through the WHO regional offices. Technical assistance will be provided to any WHO regional office willing to translate the full recommendation into any of the six UN languages.
Implementation considerations
The successful introduction of evidence-based policies (related to the prevention and management of PPH) into national programmes and healthcare services depends on well planned and participatory, consensus-driven processes of adaptation and implementation. These processes may include the development or revision of existing national guidelines or protocols based on this document. TXA should be included as part of the standard package for PPH treatment. It should therefore be available at all times in the labour room of facilities providing emergency obstetric care.
Due consideration should be given to any specific manufacturer’s instructions on precautions and contraindications. TXA for injection may be mixed with most solutions for infusion, such as electrolyte solutions, carbohydrate solutions, amino acid solutions and dextran solutions.20 TXA should be administered as a bolus IV injection over 10 minutes, as there is a potential risk of transient lowering of blood pressure. TXA should not be mixed with blood for transfusion, solutions containing penicillin or mannitol.20 It can be administered via the same IV cannula used for IV hydration or uterotonic administration.
An enabling environment should be created for the use of TXA (for example, by widening its availability) in order to support changes in the behaviour of healthcare practitioners to enable the use of evidence-based practice. This includes technical support for local guideline implementers in the development of training manuals, flowcharts and quality indicators as well as their participation in stakeholders’ meetings. Local professional societies play important roles in this process, and an inclusive and participatory process should be encouraged.
Health facilities where emergency obstetric care is provided need to have the necessary supplies and equipment, as well as the necessary training for staff attending births, so that TXA can be administered safely by IV infusion. The shelf life of TXA is generally three years, and can be stored at room temperature (15 to 30 degrees Celsius). The opened product must be used immediately. The manufacturer’s instructions on storage and use, however, should always be given precedence.
The recommendation should be adapted into locally appropriate documents that are able to meet the specific needs of each country and health service. Modifications to the recommendation should be justified in an explicit and transparent manner.
