Improving postpartum hemorrhage care: Policy, practice, and research

Ameh, Charles; Althabe, Fernando

doi:10.1002/ijgo.14271

Cited by 3 publications

(1 citation statement)

References 7 publications

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“…The centre will typically be a tertiary hospital, with capacity for antenatal diagnosis and preoperative planning in management of the most invasive forms of PAS (11)(12)(13)(14)(15).…”

Section: Introductionmentioning

confidence: 99%

Evaluating the quality of care for suspected placenta accreta spectrum referred to a regional PAS centre in Semarang, Indonesia

Cahyanti,

Wiyati,

Dewantiningrum

et al. 2024

Preprint

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Background In low middle income countries (LMICs), the increase in the rate of caesarean surgery, a main risk of placenta accreta spectrum (PAS), and limited resources to manage it. In Indonesia a PAS clinical guideline was developed, and disseminated, a regional PAS Centre was set up within a functional comprehensive emergency obstetric care (CEmOC) and the quality of care provided afterwards evaluated. Study Design: A retrospective cohort study design that included all suspected PAS cases referred in between January 2020 to December 2022, in Semarang, Indonesia. The study compared the quality of care provided for invasive and non-invasive cases. Differences in quality of care in each outcome group was explored at different shifts and periods of the day, public holidays or weekends and weekdays. The quality of 24/7 care based on maternal outcome, timeliness of emergency care, and adherence to national PAS management guidelines was evaluated. Results Ninety-nine of the 154 (64.28%) referral patients with suspected PAS were in the invasion group. Of these, 81 (81.8%) were diagnosed prenatally and confirmed at surgery or histopathology. The quality of care was similar between women with and without invasion regardless of time intervention. The multidisciplinary team and blood unit availability were found to be the key performance of adherence to the standard process.. The decision to delivery interval (DDI) of ≤ 30 minutes was the most important missing element in the timeliness of emergency care, with median (IQR) 57.50 (30–120) minutes on weekdays and 43.00 (20–66) minutes on public holidays and weekends in the invasion group. Nevertheless, in emergency cases, the access to ICU and time to transfusion in invasion group was adequate. A reduction in case fatality rate (CFR) of PAS was observed from 4.0% (2020) to 3.03% (2022). Conclusions The findings suggest that the regional PAS centre is functioning optimally according to national PAS guidelines, with no difference in the quality of care provided to all referred suspected PAS cases irrespective of the degree of placental invasion, the time of the day or period of the week.

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“…The centre will typically be a tertiary hospital, with capacity for antenatal diagnosis and preoperative planning in management of the most invasive forms of PAS (11)(12)(13)(14)(15).…”

Section: Introductionmentioning

confidence: 99%

Evaluating the quality of care for suspected placenta accreta spectrum referred to a regional PAS centre in Semarang, Indonesia

Cahyanti,

Wiyati,

Dewantiningrum

et al. 2024

Preprint

Self Cite

View full text Add to dashboard Cite

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Postpartum Hemorrhage

Wang,

Oyelese

2024

Maternal-Fetal Medicine

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Obstetric hemorrhage is the leading cause of maternal death in childbirth; it is estimated that one woman dies every four minutes from postpartum hemorrhage (PPH). PPH is the cause of approximately one-quarter of maternal deaths worldwide and is thus a major public health issue of great importance. Despite modern advances in medicine, hemorrhage continues to lead the causes of pregnancy-related death in most countries, with increasing disparity between countries with highly developed and underdeveloped national healthcare systems. Most deaths caused by PPH are preventable. All involved in the care of pregnant women must be aware of the gravity of this problem, ways of identifying women at risk for severe hemorrhage at childbirth, strategies for preventing and ameliorating blood loss at delivery, and finally ways to deal with obstetric hemorrhage when it does occur. This article reviews the impact of obstetric hemorrhage, the controversy regarding definitions, diagnosis, epidemiology, pathophysiology, and management of obstetric hemorrhage.

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Postpartum haemorrhage: latest developments in prediction, drug treatment and monitoring

Phan,

Weeks

2024

British Journal of Midwifery

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With increasing global rates of postpartum haemorrhage, recent developments aim to ensure that birthing women are safe. This focused review will discuss developments in prediction of postpartum haemorrhage, blood loss measurement, uterotonic use and the thromboelastogram, aiming to improve prevention and treatment of postpartum haemorrhage. The unpredictable nature of postpartum haemorrhage is a significant hurdle, as all women must be considered at risk, imposing a heavy burden on healthcare services. Evidence-based tools have shown promise in improving prediction and management strategies. However, the lack of consensus and agreement on risk factors presents obstacles to developing accurate models. Ongoing research is exploring the development of an individual postpartum haemorrhage risk index, providing personalised care to pregnant women. Accurate blood loss quantification is essential for prompt postpartum haemorrhage diagnosis and appropriate interventions, but challenging in busy clinical settings. Recent advancements in prophylaxis and treatment using medication (uterotonics and tranexamic acid), as well as in monitoring using thromboelastograms, emphasise the need for effective prediction and management strategies. This critical review underscores the need for further research to enhance prediction tools, refine management protocols and address existing challenges to improve maternal outcomes.

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Improving postpartum hemorrhage care: Policy, practice, and research

Abstract: SynopsisReducing the risk of death from PPH requires evidence‐based care, innovations, and addressing demand and supply‐side bottlenecks around quality, availability, and use of uterotonics.

Cited by 3 publications

References 7 publications

Evaluating the quality of care for suspected placenta accreta spectrum referred to a regional PAS centre in Semarang, Indonesia

Evaluating the quality of care for suspected placenta accreta spectrum referred to a regional PAS centre in Semarang, Indonesia

Postpartum Hemorrhage

Postpartum haemorrhage: latest developments in prediction, drug treatment and monitoring

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