Evaluation of a multifaceted postpartum hemorrhage‐management intervention in community hospitals in Southern Thailand

Liabsuetrakul, Tippawan; Palanukunwong, Kanokporn; Chinduereh, Anan; Oumudee, Nurlisa

doi:10.1002/ijgo.12253

Cited by 4 publications

(3 citation statements)

References 26 publications

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“…However, the effect on clinical outcomes was not identified in this study. A significant improvement of active care, particularly in the use of indwelling bladder catheters Original Article SMJ 24 and 2 randomized-controlled trials [25][26] , as well as 3 before-and-after quasi-experimental trials. 20,27,28 Although these studies showed a variation in the outcomes monitored of PPH, the use of multifaceted intervention was a common strategy for preventing PPH and improving its management.…”

Section: Discussionmentioning

confidence: 99%

Multifaceted Intervention to Improve the Quality of Care for Postpartum Hemorrhage

Liabsuetrakul¹,

Lindmark²,

Talungchit³

2020

Smj

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Objective: To evaluate the effect of a multifaceted intervention on the quality of care and clinical outcomes for postpartum hemorrhage (PPH) as measured by adherence and acceptability to indicators of PPH management at district and referral levels. Methods: A quasi-experimental study of interventions was conducted to improve healthcare for PPH in 6 district and 3 referral hospitals in southern Thailand. Multifaceted intervention included educational outreach, audit and feedback, reminders, and the involvement of an opinion leader. Physicians and nurses responsible for case management and care policies (145 individuals) in the aforementioned hospitals participated in the intervention. Medical records were reviewed considering the checklist of indicators for district and referral levels. Results: All indicators for PPH management were accepted by at least 80% of the participants, except for surgical intervention. We reviewed the medical records of 805 women diagnosed with PPH. Of these, during the pre-and post-intervention periods, 132 and 142 were from district hospitals, and 228 and 303 from referral hospitals, respectively. The use of an indwelling bladder catheter and hemodynamic monitoring were significantly increased in the post-intervention period. Conclusion: Quality of care for postpartum hemorrhage improved after implementing a multifaceted intervention targeting healthcare providers. The results of this study can be applied to other hospitals with a similar setting regarding the eligible criteria. Severe maternal morbidity and mortality from PPH should be monitored.

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Section: Discussionmentioning

confidence: 99%

Multifaceted Intervention to Improve the Quality of Care for Postpartum Hemorrhage

Liabsuetrakul¹,

Lindmark²,

Talungchit³

2020

Smj

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“…At maternity level, despite the inconclusive Pithagore-6 cluster RCT 26 , community-based multifaceted interventions, aimed at improving the translation into clinical practices of the guidelines for PPH management, have gained attention in recent years and even proved effectiveness in low-middle income countries. 39 At individual level, oxytocin infusion is mandatory for the prevention of third-stage labour and postpartum bleeding risks. In the presence of PPH, re-administration of oxytocin should be prompt, as it was shown ineffective when performed more than 20 min after onset of PPH to avoid progression towards S-PPH.…”

Section: Discussionmentioning

confidence: 99%

Factors associated with severe postpartum haemorrhage: systematic review using Bradford Hill’s causality framework

Stachetti¹,

Spodenkiewicz²,

Winer³

et al. 2019

Journal of Global Health Reports

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Back Background ground Severe postpartum haemorrhage (S-PPH) is the leading cause of maternal death worldwide. We aimed to provide an up-to-date summary about S-PPH determinants. Methods Methods We performed a systematic review following the Preferred Reporting Items for Systematic reviews and Meta-analysis (PRISMA) guidelines. We searched the terms "risk factor", "determinant", "post-partum haemorrhage" and "severe", within Web of Science, Scopus, Science Direct, Medline, Cochrane, and Clinical Trials.gov databases. The primary endpoint was S-PPH, defined as a blood loss ≥1,000 mL a second-line treatment, a PPH-related blood transfusion, a peripartum decrease in haemoglobin level or a PPH-related maternal death. All interventional and observational studies about risks factors for S-PPH published in English or French between January 1, 2004 and August 31, 2018 were eligible. Because studies used very different definitions of S-PPH, meta-analysis was ruled out and we gauged the risk factors using the Bradford Hill's criteria causality framework. R Results esults Amongst 1,193 identified abstracts, we selected fourteen studies that collected information on 9,271,519 parturient women (35,825 with S-PPH). Key established determinants of S-PPH were previous PPH, previous caesarean, multiple pregnancy, abnormal placentation, preeclampsia, labour induction, prolonged labour, placental retention, uterine rupture, uterine atony, uterine fibroids, macrosomia, birth canal injuries, instrumental vaginal and caesarean deliveries. Most of associated factors of uncertain significance belonged to socio-environmental characteristics. Biological parameters were all classified as indicators of risk. C Conclusions onclusions The key established determinants of S-PPH are of primarily obstetrical nature. New avenues of research, including contextual studies, are needed to improve the management of severe obstetrical morbidity.

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“…Interestingly, previous studies have reported a relatively high maternal mortality among the minorities in Thailand [ 17 , 18 ]. Therefore, consideration of local or context-specific risk factors, such as race, ethnicity, socioeconomic status, cultural belief, and accessibility to health care services, might be crucial [ 18 ].…”

Section: Introductionmentioning

confidence: 99%

Risk Factors for Postpartum Hemorrhage in a Thai–Myanmar Border Community Hospital: A Nested Case-Control Study

Thepampan¹,

Eungapithum²,

Tanasombatkul

et al. 2021

IJERPH

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Postpartum hemorrhage (PPH) is a common complication of pregnancy and a global public health concern. Even though PPH risk factors were extensively studied and reported in literature, almost all studies were conducted in non-Asian countries or tertiary care centers. Our study aimed to explore relevant risk factors for PPH among pregnant women who underwent transvaginal delivery at a Thai–Myanmar border community hospital in Northern Thailand. An exploratory nested case-control study was conducted to explore risk factors for PPH. Women who delivered transvaginal births at Maesai hospital from 2014 to 2018 were included. Two PPH definitions were used, which were ≥ 500 mL and 1000 mL of estimated blood loss within 24 h after delivery. Multivariable conditional logistic regression was used to identify significant risk factors for PPH and severe PPH. Of 4774 women with vaginal births, there were 265 (5.55%) PPH cases. Eight factors were identified as independent predictors for PPH and severe PPH: elderly pregnancy, minority groups, nulliparous, previous PPH history, BMI ≥ 35 kg/m2, requiring manual removal of placenta, labor augmentation, and fetal weight > 4000 gm. Apart from clinical factors, particular attention should be given to pregnant women who were minority groups as PPH risk significantly increased in this population.

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Evaluation of a multifaceted postpartum hemorrhage‐management intervention in community hospitals in Southern Thailand

Abstract: Implementation of the multifaceted intervention improved PPH management at community hospitals.

Cited by 4 publications

References 26 publications

Multifaceted Intervention to Improve the Quality of Care for Postpartum Hemorrhage

Multifaceted Intervention to Improve the Quality of Care for Postpartum Hemorrhage

Factors associated with severe postpartum haemorrhage: systematic review using Bradford Hill’s causality framework

Risk Factors for Postpartum Hemorrhage in a Thai–Myanmar Border Community Hospital: A Nested Case-Control Study

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