Prevention and treatment of postpartum hemorrhage in low-resource settings

Lalonde, André B.

doi:10.1016/j.ijgo.2012.03.001

Cited by 180 publications

(110 citation statements)

References 31 publications

(33 reference statements)

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“…The study limitations include: [1] major obstetric hemorrhage was a rare event in our series; [2] the a priori definition of transfusion of C5 pRBC units was at the discretion of the senior physician and hence some cases may have had major obstetric hemorrhage, but units needed/used were underestimated; [3] relevant risk factors such as body mass index/obesity were not captured for the control group and hence no comparative analyses were possible; [4] major obstetric hemorrhage patients who underwent uterine conservation techniques to control major obstetric hemorrhage are few and thus the discrete implication on outcomes is difficult to assess; and [5] cultural and health insurance homogeneity of the cohorts makes extrapolation to other populations difficult.…”

Section: Discussionmentioning

confidence: 96%

“…The strengths of our study include: [1] a single facility population with only in-hospital cases; [2] large sample size and case matching within the same in-hospital population; [3] statistical models with high accuracy values; [4] use of the same validated database and blood bank reports, reducing ascertainment bias and misclassifications; [5] inclusion only of cases transfused versus blood bank requests to prepare blood products; [6] criteria of C5 p RBC units reflecting genuine hemodynamic instability; [7] real-time records of delivery data, anesthesia, and neonatal outcome [8]. Overall, the analysis showed a high C statistics value reflective of outstanding discriminatory power of the model for the risk factors identified.…”

Section: Discussionmentioning

confidence: 99%

“…As much as 30 %, and in some countries more than 50 % of maternal mortality, is due to hemorrhage, primarily in the postpartum period [2][3][4]. The challenge of identifying and reducing risk factors for major obstetric hemorrhage is also relevant in developed countries where these events are increasingly seen [5][6][7], especially because of complications of overinvasive placentation and postpartum hemorrhage (PPH) [8][9][10][11][12].…”

mentioning

confidence: 99%

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Revisit of risk factors for major obstetric hemorrhage: insights from a large medical center

Helman

Drukker

Fruchtman

et al. 2015

Arch Gynecol Obstet

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Revisit of risk factors for major obstetric hemorrhage: insights from a large medical center

Helman

Drukker

Fruchtman

et al. 2015

Arch Gynecol Obstet

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“…Therefore, we did not review PPH guidelines by the World Health Organization 22 and the International Federation of Gynecology and Obstetrics, 23 which are more clinically relevant to providers in low-resource settings. Four authors (R.S., C.F.W., N.A., A.J.B.)…”

Section: Methodsmentioning

confidence: 99%

National and International Guidelines for Patient Blood Management in Obstetrics: A Qualitative Review

Shaylor

Weiniger

Austin

et al. 2017

Anesthesia &Amp; Analgesia

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In developed countries, rates of postpartum hemorrhage (PPH) requiring transfusion have been increasing. As a result, anesthesiologists are being increasingly called upon to assist with the management of patients with severe PPH. First responders, including anesthesiologists, may adopt Patient Blood Management (PBM) recommendations of national societies or other agencies. However, it is unclear whether national and international obstetric societies’ PPH guidelines account for contemporary PBM practices. We performed a qualitative review of PBM recommendations published by the following national obstetric societies and international groups: the American College of Obstetricians and Gynecologists; The Royal College of Obstetricians and Gynecologists, United Kingdom; The Royal Australian and New Zealand College of Obstetricians and Gynecologists; The Society of Obstetricians and Gynecologists of Canada; an interdisciplinary group of experts from Austria, Germany, and Switzerland; an international multidisciplinary consensus group; and the French College of Gynaecologists and Obstetricians. We also reviewed a PPH bundle, published by The National Partnership for Maternal Safety. On the basis of our review, we identified important differences in national and international societies’ recommendations for transfusion and PBM. In the light of PBM advances in the nonobstetric setting, obstetric societies should determine the applicability of these recommendations in the obstetric setting. Partnerships among medical, obstetric, and anesthetic societies may also help standardize transfusion and PBM guidelines in obstetrics.

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“…Unique guidelines were created for the FRPC. They were based on the recommendations for PPH management issued by the World Health Organization (WHO) [5], the International Federation of Gynaecology and Obstetrics (FIGO) [6] and the California Maternal Quality Care Collaborative (CMQCC) [7]. The guidelines consisted of a theoretical part, algorithms (Fig.…”

Section: Methodsmentioning

confidence: 99%

The impact of the implementation of the postpartum haemorrhage management guidelines at the first regional perinatal centre in Southern Kazakhstan

Nadišauskienė

Dobožinskas

Kačerauskienė

et al. 2016

BMC Pregnancy Childbirth

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BackgroundPostpartum haemorrhage (PPH) remains one of the most common causes of maternal morbidity and mortality. Therefore, clearly written PPH management guidelines should be used in clinical practice. The aim of this study was to evaluate the effectiveness of the implementation of PPH management guidelines at the First Regional Perinatal Centre of Southern Kazakhstan (FRPC).MethodsBetween 2012 and 2013 an interventional study was performed whereby the PPH management guidelines were implemented at the FRPC. All of the deliveries that were complicated by PPH 8 months before and 8 months after the intervention were analysed. Prevalence and severity of PPH, and the change in prevention, diagnostics and management of PPH was evaluated and statistical analysis using the SPSS 22.0 was performed.ResultsThere were in total 5404 and 5956 deliveries in the pre- and post-intervention periods, respectively. The rates of PPH and severe PPH decreased from 1.17 to 1.02 % (p = 0.94) and from 0.24 to 0.22 % (p = 0.94), respectively. Blood loss on average increased from 1055 to 1170 ml in the post-intervention period. The pharmacological treatment of postpartum haemorrhage with uterotonics was administered most frequently during both periods. After the implementation of the guidelines, the number of transfused units of packed red blood cells decreased from 4.76 to 2.48 units/case. In addition, the amount of transfused fresh frozen plasma decreased by 20 %. The number of conservative interventions and conservative operations increased from 7.9 to 52.7 % and from 3.9 to 48.6 %, respectively. The number of hysterectomies decreased from 23.7 % in pre-intervention to 8.1 % in the post-intervention period.ConclusionsThe implementation of the PPH management guidelines had a positive effect on PPH prevention, diagnostics and management. It led to a more conservative aproach to the treatment of PPH. Therefore, clearly written PPH management guidelines, adapted for a particular hospital, should be developed and used in clinical practice.

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Prevention and treatment of postpartum hemorrhage in low-resource settings

Cited by 180 publications

References 31 publications

Revisit of risk factors for major obstetric hemorrhage: insights from a large medical center

Revisit of risk factors for major obstetric hemorrhage: insights from a large medical center

National and International Guidelines for Patient Blood Management in Obstetrics: A Qualitative Review

The impact of the implementation of the postpartum haemorrhage management guidelines at the first regional perinatal centre in Southern Kazakhstan

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