Guideline‐based development of quality indicators for prevention and management of postpartum hemorrhage

Woiski, Mallory; Scheepers, Hubertina C.J.; Liefers, Janine; Lancé, Marcus D.; Middeldorp, Johanna M.; Lotgering, F.K.; Grol, Richard; Hermens, Rosella

doi:10.1111/aogs.12718

Cited by 21 publications

(24 citation statements)

References 46 publications

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“…The structure of the interview was based on previously developed quality indicators and the two theoretical frameworks. The quality indicators, which were based on PPH-guidelines and ATLS-based course instructions, consisted of the following five domains: 1) Prevention of PPH, 2) Management of patients with >500 ml blood loss, 3) Management of patients with >1000 ml blood loss or with signs of shock and 4) Organisation of PPH-care and 5) Management of patients with >2000 ml blood loss [ 27 ]. All participants were asked to mention obstacles and facilitators for providing high quality care on the subjects of the first four domains, particularly regarding adherence to evidence-based guidelines and ATLS-based course instructions.…”

Section: Methodsmentioning

confidence: 99%

Influencing factors for high quality care on postpartum haemorrhage in the Netherlands: patient and professional perspectives

Woiski

Belfroid²,

Liefers³

et al. 2015

BMC Pregnancy Childbirth

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BackgroundPostpartum haemorrhage (PPH) remains a major contributor to maternal morbidity even in high resource settings, despite the development and dissemination of evidence-based guidelines and Advance-Trauma-Life-Support (ATLS) based courses for optimal management of PPH. We aimed to assess current influencing factors (obstacles and facilitators) for the delivery of high quality PPH-care from both patient and professional perspective.MethodsWe qualitatively explored influencing factors for delivering high quality PPH-care, by having individual interviews with PPH-patients and focus group interviews with the different types of professionals working in the delivery room. For both perspectives, the theoretical frameworks of Grol and Cabana were used to classify the influencing factors for optimal PPH-care (factors of the guidelines, of professionals, of patients, of the social setting and of the organisation). In order to assess the importance of the influencing factors found among the professionals, we quantified these factors in a web-based questionnaire.ResultsA total of 12 patients and 41 professionals participated in the interviews, and 315 complete surveys were analyzed. The main obstacle for high quality PPH-care identified by patients was the lack of information given by the professionals to the patient and partner before, during and after the PPH event. An informative patient website, a patient leaflet and a follow-up consultation were mentioned as facilitators. The main obstacles according to the professionals were: lack of clarity of the guidelines, lack of knowledge and failing team-communication. Team training and checklists/ flowcharts were considered facilitators.ConclusionsDifferent obstacles to the delivery of high quality PPH-care were identified by both patients and professionals. These data can be used to develop a focused strategy to improve PPH-care.Trial registrationNCT 00928863

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Section: Methodsmentioning

confidence: 99%

Influencing factors for high quality care on postpartum haemorrhage in the Netherlands: patient and professional perspectives

Woiski

Belfroid²,

Liefers³

et al. 2015

BMC Pregnancy Childbirth

Self Cite

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“…But some problems could not be overlooked, gestational hypertension, preeclampsia, heart disease, glaucoma, asthma and drug hypersensitivity were uterotonic contraindications, and drug life-time limits its repeated usage in a short time, uterotonics also brought side effect like nausea, vomiting, diarrhea, headache and increased blood pressure [8] , a systematic review in 2015 even found no satisfactory evidence could suggest what kind of uterotonic was the most effective for uterine atony [18] . Two previous studies mentioned so-called clamp for xing intrauterine balloon, or recommending Bilateral Cervix Apex Clamping (BCAC) procedure as a noninvasive therapy for severe postpartum hemorrhage [11,19] , both operations were completely different from bilateral-contralateral cervix clamp we proposed. The present study found this new technique could effectively reduce blood loss at third stage of labor or after vaginal/caesarean birth, and it was much safer than uterotonics.…”

Section: Discussionmentioning

confidence: 97%

The new clinical application of bilateral-contralateral cervix clamp in postpartum hemorrhage: a retrospective cohort study

Zhang

et al. 2020

Preprint

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Background: To assess the efficacy and safety of bilateral-contralateral cervix clamp firstly applied in postpartum hemorrhage caused by uterine tony of lower segment.Methods: Totally 47 pregnant women with postpartum hemorrhage secondary to lower uterine segment atony in vaginal delivery or after caesarean delivery were included from March 1, 2020 to May 31, 2020. According to patient’s informed consent, 22 women accepted cervical clamp to treat and 25 only used uterotonics in control group.Then hemostatic efficacy and safety of bilateral-contralateral cervix clamp were assessed by retrospective analysis.Results: It was found that mean blood loss in clamp group was much less during vaginal delivery (656.2±72.79g vs 811.8±86.07g, p=0.001) or after caesarean delivery (42.8±6.60g vs 126.3±86.97g, p=0.007), and incidence of uterotonic repeated usage (81.8% vs 36%, 18.2 % vs 64%, p=0.001) or side effect (18.2% vs 48.0%, p=0.031) appeared less than control group, but there was no statistical differences on hospital stay(4.1±1.57days vs 3.8±1.61days, p=0.535), hemoglobin(119±4.10g vs 121.4±4.19g, p=0.058)，blood transfusion(9.1% vs 12%,p=0.746), surgical procedures(4.5% vs 4.0%, p=0.93), also no clamp complications occurred.Conclusions: The bilateral-contralateral cervix clamp was effective and safe, this new technique could be a complementary treatment for postpartum hemorrhage.

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“…In our study, there were three merits of using the TSCLB to measure the amount of blood loss in vaginal delivery. First, it was extremely di cult to measure the actual amount of blood loss by visual estimation methods, because blood and amniotic uid are often mixed during childbirth [23]. We designed the new TSLCB for vaginal delivery, which allowed the blood to be separated from the amniotic uid by collecting the components in two transparent plastic bags.…”

Section: Discussionmentioning

confidence: 99%

Measurement of Postpartum Blood Loss Using a New Two - Set Liquid Collection Bag for Vaginal Delivery: A Prospective, Randomized, Case Control Study

Wang

Weng

et al. 2020

Preprint

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Background Postpartum hemorrhage (PPH) is a major obstetric complication, and the real-time measurement of blood loss is important in the management and treatment of PPH. We designed a new two-set liquid collection bag (TSLCB) for measuring postpartum blood loss in vaginal delivery. The aim of this study was to evaluate the effectiveness of the TSLCB in separating the blood from the amniotic fluid during vaginal delivery and in determining the accuracy of the measured postpartum blood loss.Methods A prospective, randomized, case control study was conducted in the Women’s Hospital, Zhejiang University School of Medicine, from March 2018 to April 2018. Sixty single pregnant women with spontaneous labor at 37–41 weeks without maternal complications were randomly divided into the experimental and control groups. The TSLCB was used to evaluate separately the amount of blood and amniotic fluid. For the control group, visual estimation and traditional plastic blood-collecting consumables were used to estimate the amount of postpartum blood loss. The measured blood loss between the two groups was compared, and the association of the measured blood loss with various clinical lab indices and vital signs was investigated. Results The TSLCB (the experimental group) improved the detection of the measured blood loss compared with visual estimation and the traditional method (the control group) (p < 0.05). In the experimental group, correlation analysis showed that the measured blood loss at delivery and within 24 h of delivery was significantly associated with the decreased hemoglobin level, red blood cell count, and hematocrit level of patients (r = -0.574, -0.455, -0.437; r = 0.-595, -0.368, -0.374; p < 0.05). In the control group, only the measured blood loss within 24 h of delivery was associated with the decreased hemoglobin level (r = -0.395, p < 0.05). No blood transfusion and plasma expanders were required in the treatment of PPH for both groups.Conclusions The TSLCB can be used to accurately measure the postpartum blood loss in vaginal delivery by medical personnel.Trial registration: This trial was registered with Chinese Clinical Trial Registry (ChiCTR): ChiCTR-IOR-17012453, 23 August 2017.

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Guideline‐based development of quality indicators for prevention and management of postpartum hemorrhage

Abstract: This study describes a stepwise systematic development of 22 performance and organizational indicators to use for measuring the whole care process of prevention and management of PPH.

Cited by 21 publications

References 46 publications

Influencing factors for high quality care on postpartum haemorrhage in the Netherlands: patient and professional perspectives

Influencing factors for high quality care on postpartum haemorrhage in the Netherlands: patient and professional perspectives

The new clinical application of bilateral-contralateral cervix clamp in postpartum hemorrhage: a retrospective cohort study

Measurement of Postpartum Blood Loss Using a New Two - Set Liquid Collection Bag for Vaginal Delivery: A Prospective, Randomized, Case Control Study

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