A study of the healthcare resource use for the management of postpartum haemorrhage in France, Italy, the Netherlands, and the UK

Abstract

Objective: Postpartum haemorrhage (PPH) complicates approximately 5% of births worldwide and is a leading direct cause of maternal death. Rates of PPH are increasing in many developed countries, particularly PPH related to uterine atony. There is a lack of published up-to-date information about healthcare resource use associated with management of PPH following vaginal birth. The objective of this study was to describe healthcare resource use for the management of minor PPH (blood loss 500-1,000 ml) and major PPH (blood loss > 1,000 ml) compared to uncomplicated birth (no PPH) following hospital vaginal birth in France, Italy, the Netherlands, and the UK. Study design: In-depth interviews with two midwives from each participating country were conducted to establish differences in resource use for the management of minor PPH, major PPH, and uncomplicated birth. A web-survey was then developed and one obstetrician per participating country reviewed the survey. In total, 100 midwives (25 per country) completed the survey. Results were discussed at a multiprofessional consensus meeting of midwives and obstetricians/gynaecologists (n = 6). Results and conclusions: Midwives participating in the survey estimated that 80% of women receive Active Management of the Third Stage of Labour (AMTSL) and 93% of participants specified that uterotonics would routinely be used during AMTSL. Most participants (84%) reported that blood loss is routinely measured in their hospital, using a combination of methods. PPH is associated with increased healthcare resource use, including administration of additional uterotonics and use of additional medical interventions, such as urinary catheter, intravenous fluids, and possible requirement for surgery. The number of nurses, obstetricians/gynaecologists, and anaesthetists involved in the management of PPH increases with the occurrence and severity of PPH, as well as the proportion of healthcare personnel providing continuous care. Women may spend an additional 24 h in hospital following major PPH compared to uncomplicated birth. The results of this study highlight the burden of PPH management on healthcare resources. To reduce costs associated with PPH, prevention is the most effective strategy and can be enhanced with the use of an effective uterotonic as part of the active management of the third stage of labour.

Effect of High Fidelity Simulation on Intern Students' Competency regarding Clinical Guidelines for Active Management of the Third Stage of Labor

“…Understanding the nature and physiological changes of the third stage of labor as well as applying the clinical guidelines for active management of the third stage of labor are essential for preventing the serious complications especially postpartum hemorrhage (5) . This accommodate with the recommendations of World Health Organization (WHO), National Institute for Health and Care Excellence (NICE), the International Federation of Gynecologists and Obstetricians (FIGO) and the International Confederation of Midwives (ICM) (6)(7)(8) .…”

“…Then, clamping and cutting the cord after cessation of its pulsation or approximately from 2-3 minutes after birth of the newborn. This is followed by applying controlled cord traction (CCT) for placental delivery (6,11) . These previous steps are implemented alongside with the provision of immediate neonatal assessment of breathing, performing resuscitation if needed and applying maternal-fetal skin-to-skin contact.…”

Thromboprophylaxis during pregnancy and the puerperium: a systematic review and economic evaluation to estimate the value of future research

“…However, when UK-specific midwives were questioned (N = 25), it was suggested the estimated additional length of stay attributable to a major PPH would be longer at 2.3 days. 101 Based on these data, it is possible that the cost of an admission for GI bleeding is higher than the additional cost of managing a major PPH in a woman already admitted for delivery. Given the likely heterogeneity associated with…”

Use of tranexamic acid at the time of delivery

“…Different techniques have been studied in prevention of PPH (3)(4)(5)(6)(7)(8)(9)(10)(11). Active management of the third stage of labor should be used routinely to reduce its incidence (4).…”