Postpartum hemorrhage prevention through audit and review of literature
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20251985Keywords:
Clinical audit, Midwifery, Obstetrics, Postpartum hemorrhage, Quality improvementAbstract
Background: Postpartum haemorrhage (PPH), particularly significant cases with blood loss >1000 ml, is a critical obstetric emergency. This audit evaluated PPH management at Khaja Banda Nawaz Teaching and General Hospital, addressing a high incidence of PPH (29.5%).
Methods: A retrospective audit, at Khaja Banda Nawaz Teaching and General Hospital, Kalburgi, Karnataka, India conducted between period of February and May 2024, reviewed 1786 vaginal births from 2022 to 2023, identifying 526 PPH cases (>500 ml), including 71 cases of PPH>1000 ml (4%) and 20 cases ≥2000 ml (1.1%). Compliance with NICE guideline NG235 standards was assessed. Recommendations were implemented from June 2024 to February 2025, followed by a reaudit of 500 vaginal births from February to May 2025, focusing on 14 cases of PPH >1000 ml (2.8%).
Results: The initial audit revealed deficiencies in 56% of PPH records, including inadequate monitoring (35%), delayed uterotonic administration (15%), and delayed transfer from the postpartum ward to the emergency operating unit (59%). Post-intervention, documentation of informed choice improved (78% versus 49%), and significant PPH incidence decreased (2.8% versus 4%). Active third stage management increased (73% versus 27% physiological).
Conclusions: The audit cycle reduced significant PPH through standardized protocols and team engagement, underscoring the value of continuous auditing in midwifery-led units.
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References
Mohamed T, Chandraharan E. Recognition and management of postpartum hemorrhage. Matern Fet Med. 2024;7(1):29-37. DOI: https://doi.org/10.1097/FM9.0000000000000256
Felis S. Postpartum hemorrhage. Am J Med Clin Res Rev. 2023:1-28. DOI: https://doi.org/10.47363/JCCEM/2023(2)134
Guasch E, Brogly N, Gilsanz F. Improving outcomes in postpartum haemorrhage: recognition and resuscitation. Reg Anesth Pain Med. 2023;48:A369-71. DOI: https://doi.org/10.1136/rapm-2023-ESRA.678
Giouleka S. Postpartum hemorrhage: a comprehensive review of guidelines. Obstet Gynecol Surv. 2022;77(11):665-82. DOI: https://doi.org/10.1097/OGX.0000000000001061
Sadiku OD, Aina SA, Odoemene CC, Ogunmoyin TE, Adedara VO, Olasimbo O, et al. Approaches to the prevention and treatment of postpartum hemorrhage: a systematic review of past advances, recent developments, and best practices. Cureus. 2024;16(8):e65096. DOI: https://doi.org/10.7759/cureus.65096
Liu LY, Nathan L, Sheen JJ, Goffman D. Review of current insights and therapeutic approaches for the treatment of refractory postpartum hemorrhage. Int J Women's Health. 2023:905-26. DOI: https://doi.org/10.2147/IJWH.S366675
Kumar S, Gaiwal A. Management of postpartum hemorrhage- current strategies. MGM J Med Sci. 2022;9(4):374-8. DOI: https://doi.org/10.4103/mgmj.mgmj_149_22
Kubuka AE, Humbuyu JM, Mkangala GJ. Postpartum haemorrhage: a review from evidence. Nurs Care Open Access J. 2023;9(2):74-8. DOI: https://doi.org/10.15406/ncoaj.2023.09.00274
National Institute for Health and Care Excellence. Intrapartum care for healthy women and babies. NICE guideline [NG235]. London: NICE; 2024.
Mavrides E, Allard S, Chandraharan E, Collins P, Green L, Hunt BJ, et al. Prevention and management of postpartum haemorrhage: Green-top Guideline No. 52. BJOG. 2016;124(5):e106-49. DOI: https://doi.org/10.1111/1471-0528.14178
Driessen M, Bouvier-Colle MH, Dupont C, Khoshnood B, Rudigoz RC, Deneux-Tharaux C. Postpartum hemorrhage resulting from uterine atony after vaginal delivery: factors associated with severity. Obstet Gynecol. 2011;117(1):21-31. DOI: https://doi.org/10.1097/AOG.0b013e318202c845
Akter S, Forbes G, Corona MV, Miller S, Althabe F, Coomarasamy A, et al. Perceptions and experiences of the prevention, detection, and management of postpartum haemorrhage: a qualitative evidence synthesis. Cochrane Database Syst Rev. 2023;(11):CD013795. DOI: https://doi.org/10.1002/14651858.CD013795.pub2
Kaur K, Grover S, Garg S, Sharma A, Ravi R. Updates on postpartum hemorrhage: prediction, early detection and management. Int J Reprod Contracept Obstet Gynecol. 2024;13(8):2849-56. DOI: https://doi.org/10.18203/2320-1770.ijrcog20242849
Fahy K, Foureur M, Hastie C. Birth territory and midwifery guardianship: theory for practice, education and research. Edinburgh: Elsevier; 2010.
Cohain JS. Proposed protocol for third stage management. Midwife Today. 2010;95:24-5. DOI: https://doi.org/10.1111/j.1523-536X.2009.00385_2.x
Begley CM, Gyte GM, Murphy DJ, Devane D, McDonald SJ, McGuire W. Active versus expectant management in the third stage of labour. Cochrane Database Syst Rev. 2012;(3):CD007412. DOI: https://doi.org/10.1002/14651858.CD007412.pub3
Davis D. Physiological third stage of labour: support it or lose it. Br J Midwife. 2012;20(12):848-54.
Gallos ID, Devall AJ, Martin J, Middleton LJ, Beeson L, Galadanci HS, et al. Randomized Trial of Early Detection and Treatment of Postpartum Hemorrhage. N Engl J Med. 2023;389(1):11-21. DOI: https://doi.org/10.1056/NEJMoa2303966
Oyoo P, Qureshi Z, Osoti A, Gwako G, Okore J, Mugambi JK, et al. Randomized trial of early detection and treatment of postpartum hemorrhage. J Obstet Gynecol East Cent Afr. 2024;36(1):149-56. DOI: https://doi.org/10.59692/jogeca.v36i1.149
World Health Organization. A roadmap to combat postpartum haemorrhage between 2023 and 2030. Geneva: WHO; 2023.
Dupont C, Deneux-Tharaux C, Touzet S, Colin C, Bouvier-Colle MH, Lansac J, et al. Clinical audit: a useful tool for reducing severe postpartum haemorrhages? Int J Qual Health Care. 2014;26(3):262-9.
Yadav A, Mathur R, Pandita A, Sharma S, Gupta S, Mehra S, et al. Implementation of postpartum hemorrhage emergency care using a bundle approach at a tertiary care hospital in north India. J Obstet Gynecol India. 2022;72(Suppl 1):S146-52.
Lao O, Zhang X, Zhang J, Wang Y, Li Z, Chen L, et al. Prevalence and risk factors of severe postpartum hemorrhage: a retrospective cohort study. BMC Pregnancy Childbirth. 2021;21(1):332. DOI: https://doi.org/10.1186/s12884-020-03518-2
Singh S, McClure EM, Koti M, Moore JL, Goldenberg RL, Patel AB, et al. Incidence and risk factors for postpartum hemorrhage in rural India: a prospective cohort study. BMC Pregnancy Childbirth. 2020;20(1):1-9.
Escobar MF, Nassar AH, Theron G, Barnea ER, Nicholson W, Ramasauskaite D, et al. FIGO recommendations on the management of postpartum hemorrhage 2022. Int J Gynecol Obstet. 2022;157:3-50. DOI: https://doi.org/10.1002/ijgo.14116