Postpartum Haemorrhage Burden, Management and Challenges in Malaysia: A Scoping Review and Expert Recommendations for Effective Management

Abstract

Postpartum haemorrhage (PPH) and severe postpartum haemorrhage (sPPH) represent significant causes of maternal morbidity and mortality in Southeast Asia, particularly in Malaysia, where PPH remains a leading cause of maternal death. This scoping review systematically examined published literature in English-language, from January 2013 to January 2023 using PubMed and Google Scholar databases, ultimately including 16 studies that met the inclusion criteria for observational and clinical studies in pregnant women from Southeast Asia. The findings reveal substantial challenges in PPH management across the region, including inconsistent diagnostic criteria with varying blood loss thresholds, inadequate awareness among healthcare professionals and patients, and limited access to standardised treatment protocols. Cultural factors significantly impact healthcare-seeking behaviour, such as the majority of Malaysian women preferring traditional healers over medical facilities for PPH symptoms. The review identified critical gaps in blood loss estimation methods, with visual estimation being unreliable and leading to underdiagnosis, while patient intrinsic factors such as uterine atony, retained placenta, and placenta accreta spectrum disorders contribute to treatment complexity. Management approaches varied considerably, with mixed responses to first-line treatments including oxytocin, carbetocin, and misoprostol, while invasive procedures like intrauterine balloon tamponade were commonly employed for refractory cases. The study highlights the urgent need for standardised protocols, improved training of healthcare providers, and enhanced access to novel therapies such as recombinant activated factor VII, recently approved for PPH management. Expert recommendations propose revised diagnostic criteria emphasising clinical signs over absolute blood loss measurements. The review concludes that addressing PPH burden in Southeast Asia requires a multifaceted approach, including improved reporting systems, standardised treatment protocols, enhanced healthcare provider training, and adoption of evidence-based therapies adapted to resource-limited settings.