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///2018 Abstract Details
2018 Abstract Details2019-08-02T15:57:01-05:00

Postpartum Hemorrhage Guideline Comparison

Abstract Number: F4A-5
Abstract Type: Original Research

Madeleine R Alder BS1 ; Luke Liang MD2; Jane L. Holl MD, MPH3; William A. Grobman MD, MBA4; Paloma Toledo MD, MPH5

Introduction: Postpartum hemorrhage (PPH) is a leading cause of maternal morbidity and mortality both in the United States and worldwide. Several studies have suggested that these adverse outcomes from PPH are preventable; and in response, professional societies have created guidelines focused on early recognition and management of PPH. However, there has been limited evaluation of the consistency of recommendations across these guidelines. The goal of this paper is to conduct a systematic review of published PPH guidelines to assess the consistency of elements and recommendations for PPH recognition and management with a particularly emphasis on recommendations for teamwork and institutional-level interventions.

Methods: We searched PubMed, MEDline, and Cochrane library for PPH guidelines that gave recommendations about PPH recognition and management. Guidelines were identified using the words postpartum, hemorrhage, and guidelines. All articles were reviewed for applicability to PPH, and all articles that contained specific guidelines for management of PPH were included. Articles were excluded if they were general review articles, only discussed one aspect of PPH, or did not give recommendations for recognition and management. All articles had their reference lists searched for additional articles about PPH guidelines.

Guidelines were searched for recommendations. Each identified recommendation was entered into a scoring matrix, with a total of 169 possible elements. The individual elements were then grouped into the following categories: identification of risk factors, active management of the third stage of labor, approach to management of PPH, management of PPH, and systems/teamwork elements of PPH guidelines These recommendations were then compared across guidelines.

Results: Nine guidelines were identified. The ACOG guidelines contained the most elements (96 total elements) and the Malawi Ministry of health standards contained the fewest (30 elements). There was considerable variability between guidelines especially in regards to teamwork and systems-level interventions to ensure proper implementation of guidelines at the hospital level. Only six of the nine guidelines recommend the creation of a specific hospital checklist/protocol for PPH management, and only two recommended the designation of a specific multidisciplinary hemorrhage team.

Conclusions: We found considerable variability in the content of national and international guidelines for PPH recognition and management, particularly with regard to elements about teamwork. It is possible that guidelines are purposefully not overly prescriptive to facilitate adaptation for varied hospital environments; however, failure to provide recommendation to hospitals about how best to implement system-operations adaptations of their environment to ensure proper implementation of a PPH protocol may limit the reduction in maternal morbidity and mortality.

SOAP 2018