Development of an assessment and intervention protocol for postpartum hemorrhage in the mainland of China: an evidence-based method and Delphi consult

Abstract

Objective Postpartum hemorrhage (PPH) is a leading cause of maternal death. Although guidelines have been updated, those with detailed protocols are limited for nursing practice. This study aims at establishing an early assessment and intervention protocol as a toolkit for PPH for midwives and obstetrical nurses. Methods Employing the evidence-based method, a systematic Internet search of guidelines was conducted and appraisal of literatures was conducted with AGREE system and Oxman-Guyatt Overview Quality Assessment Questionnaire (OQAQ), according to which a protocol draft was therefore developed. Then, a two-round modified Delphi method was utilized to reach a consensus of the protocol built on best practices. Selection criteria for each intervention measure included consensus level with a threshold of 70%, mean of importance (M) >3.5, and coefficient of variation (CV) <0.25. Reliability of experts’ opinion was calculated by positive coefficient and authoritative coefficient. Items without consistency were enlisted in the second-round consult. When all items met the selection criteria, the protocol would be finally formulated. Results A 122-measure protocol was established, including prevention, assessment, and intervention of PPH. With a panel of 14 experts participated in the consult, the positivity coefficient was 0.93 and 1.00 for two rounds, respectively, and the authority coefficient was 0.88. After a two-round consult and revision of the draft, the final program was formulated, containing 5 first-level indexes and 14 second-level indexes with a total item of 120. Conclusions The PPH protocol, based on high-quality evidences, was formulated with a two-round Delphi method, which can provide insight for midwives and obstetrical nurses to effectively deal with PPH.

Image Analysis Application of Motherwort Total Alkaloid Injection in the Treatment of Postabortion Hemorrhage

“…Liu et al conducted an ultrasound image scanning study on the active part of the uterine contraction of Leonurus injection and found that the active parts of the excitement uterus are B1 (mainly hydrazine), B2 (mainly hydrazine, fenugreek), and B4 (mainly contains fenugreek, choline, and total amino acids), and the part of the diastolic uterus is B3 (mainly containing fenugreek and choline). The study found that no matter if motherwort injection is used alone or combined with oxytocin, both can effectively prevent and treat postpartum hemorrhage during normal delivery and uterine delivery [ 10 ]. Yu Changli and others used motherwort injection combined with oxytocin after delivery of the fetus's anterior shoulder, immediately intramuscular injection into the hip to prevent and treat postpartum hemorrhage after delivery; the results show that the combination of drugs is significantly better than the single use because the onset of oxytocin is fast, but its half-life is short (3-4 min), and the maintenance time is short, and motherwort injection has a slower onset, but has a long-lasting uterine contraction and hemostasis effect; the combined effect is complementary, the hemostatic effect is obvious, and it has the function of promoting uterine involution [ 11 ].…”