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Protocols for Postpartum Hemorrhage

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“In child-bearing women, how do protocols for postpartum hemorrhage compared with a lack of implementation of protocols affect maternal lives within the first week of birth.”

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Lydia Lester, Nicole Mitchell, W’il Greene, and Samantha Claxton

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PICOT Question

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Racial disparities in maternal health care can lead to a postpartum hemorrhage requiring transfusion.

  • Study population : 365 women from two tertiary hospitals
  • Results: African American women are less likely to receive higher levels of antihemorrhagic intervention, thus putting this population at higher risk of mortality. (C. S. et al., 2023)

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Postpartum hemorrhage simulations can improve communication during the clinical performance of a postpartum hemorrhage.

  • Study population: over 300 nursing, obstetric and anesthesia providers
  • Results: Medical professional who participated in the simulation were far more efficient in responding to a PPH and communicating during this emergency. (Dillon et al., 2021)

Severe maternal morbidity (near-miss) and its correlates in the world’s newest nation: South Sudan.

  • Study population: A total of 1,041 mothers were sampled.
  • Results: Blood transfusions should be implemented as standard protocols for better quality of life. (Alemu et al., 2019)

Intramuscular oxytocin versus oxytocin/ ergometrine versus carbetocin for prevention of primary postpartum haemorrhage after vaginal birth.

  • Study population: A total of 5712 participants are pregnant women planning a vaginal birth.
  • Results: Carbetocin is a more effective drug than oxytocin/ergometrine at preventing PPH with significantly fewer side effects. (Van der Nelson et al., 2019)

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Health care providers’ knowledge of clinical protocols for postpartum hemorrhage care in Kenya: a cross-sectional study

  • Purpose: Assess experiences and knowledge of maternity care in mostly female providers, nurse-midwives, and students
  • Results: Providers scored lower on management of refractory PPH and discharge education; Students did not differ from licensed health care workers (Henry, et. all, 2022)

Comparison of Intrauterine Balloon Tamponade and B Lynch Suture in Sever Postpartum Hemmorhage

  • Purpose: Assesses the successfulness of PPH treatment in postpartum participants ranging from ages 20-35
  • Results: significantly higher success rate using the B Lynch suture than the intrauterine balloon tamponade (decreased bleeding and hystercomy risk) (Malik, et. all, 2018)

Severe Postpartum Hemorrhage Increases Risk of Posttraumatic Stress Disorder: A Prospective Cohort Study.

  • This study presents how postpartum hemorrhage can cause women to have an increased risk for posttraumatic stress disorder if they experienced severe blood loss of greater than 2,000 milliliters (Van Steijn et al., 2020).

Postpartum Haemorrhage and Risk of Mental Ill Health: A Population-Based Study Using Linked Primary and Secondary Care Databases.

  • This study discusses how out of 42,327 women, 14,109 who experienced PPH were at an increased risk for posttraumatic stress disorder, along with other mental health risks, due to severe blood loss (Parry-Smith, William et al., 2021).

Summaries

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References

Alemu, F. M., Fuchs, M. C., Martin Vitale, T., & Abdalla Mohamed Salih, M. (2019, March 19). Severe maternal morbidity (near-miss) and its correlates in the world’s newest nation: South Sudan. International journal of women’s health.

Dillon SJ, Kleinmann W, Fomina Y, et al. “Does simulation improve clinical performance in management of postpartum hemorrhage?” Am J Obstet Gynecol 2021;225:435.e1-8.

Guan, C. S., Boyer, T. M., Darwin, K. C., Henshaw, C., Michos, E. D., Lawson, S., & Vaught, A. J. (2023). Racial disparities in care escalation for postpartum hemorrhage requiring transfusion. American journal of obstetrics & gynecology MFM, 5(6), 100938.

Henry, J., Clarke-Deelder, E., Han, D. et al. (2022). Health care providers’ knowledge of clinical protocols for postpartum hemorrhage care in Kenya: a cross-sectional study. BMC Pregnancy Childbirth 22, 828.

Liu, Cn., Yu, Fb., Xu, Yz. et al. Prevalence and risk factors of severe postpartum hemorrhage: a retrospective cohort study. BMC Pregnancy Childbirth 21, 332 (2021).

Malik, B. A., Zaib-Un-Nisa, Shabbir, A., & Saleem, M. M. (2018). Comparison of Intrauterine Balloon Tamponade and B Lynch Suture in Severe Postpartum Hemmorhage. Pakistan Armed Forces Medical Journal, (6), 1765-1770.

Parry-Smith, William et al., (2021). Postpartum Haemorrhage and Risk of Mental Ill Health: A Population-Based Longitudinal Study Using Linked Primary and Secondary Care Databases. Pages 419-425.

Van der Nelson, H., O’Brien, S., Lenguerrand, E., Marques, E., Alvarez, M., Mayer, M., Burnard, S., Siassakos, D., & Draycott, T. (2019). Intramuscular oxytocin versus oxytocin/ergometrine versus carbetocin for prevention of primary postpartum haemorrhage after vaginal birth: study protocol for a randomised controlled trial (the IMox study). Trials, 20(1), 4.

Van Steijn, Minouk E., et al.. (2020). Severe Postpartum Hemorrhage Increases Risk of Posttraumatic Stress Disorder: A Prospective Cohort Study. Results.

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Conclusion

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  • Correcting protocols can…
    • Increase confidence to act and implement care.
    • Decrease in negative postpartum hemorrhage experiences.
    • Decrease in mental health issues following giving birth.
  • Recommend modifying the protocols that are in place and providing training to healthcare workers.
    • Nursing implementations to assist protocols.
  • The articles presented material and research that supported the PICOT question.

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Compare and Contrast

What is PPH?

  • Excessive bleeding after birth
  • “The blood loss of more than 500 mL following a vaginal delivery or more than 1000 mL following cesarean section” (World Health Organization, 2021)
  • Common problem in maternal health
  • Lack of/failure to follow protocols

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  • Mental Health and Racial Disparities of PPH can compare to each other by both having a huge impact on less fortunate and both face inequalities in maternal health today.
  • Racial Disparities and the mental health of PPH contrast by how it is diagnosed and treated.
  • The articles about treatments for PPH mention the use of oxytocin as a first line preventative measure for PPH after vaginal births.
  • The articles differentiate Carbetocin as the better choice of drug as it presents with less side effects compared to Oxytocin.

Why is this Important?

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  • Severe postpartum hemorrhage (SPPH) is the leading cause of maternal deaths
  • 27% of maternal deaths worldwide
  • To help decrease complications of PPH and maternal deaths.

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(Liu, et. all, 2021)

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