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Postpartum hemorrhage care bundles to improve adherence to guidelines: A WHO technical consultation

Althabe, F; Therrien, MNS; Pingray, V; Hermida, J; Gülmezoglu, AM; Armbruster, D; Singh, N; Guha, M; Garg, LF; Souza, JP; et al. Althabe, F; Therrien, MNS; Pingray, V; Hermida, J; Gülmezoglu, AM; Armbruster, D; Singh, N; Guha, M; Garg, LF; Souza, JP; Smith, JM; Winikoff, B; Thapa, K; Hébert, E; Liljestrand, J; Downe, S; Garcia Elorrio, E; Arulkumaran, S; Byaruhanga, EK; Lissauer, DM; Ogutu, M; Dumont, A; Escobar, MF; Fuchtner, C; Lumbiganon, P; Burke, TF; Miller, S (2020) Postpartum hemorrhage care bundles to improve adherence to guidelines: A WHO technical consultation. Int J Gynaecol Obstet, 148 (3). pp. 290-299. ISSN 1879-3479 https://doi.org/10.1002/ijgo.13028
SGUL Authors: Arulkumaran, Sabaratnam

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Abstract

Objective To systematically develop evidence‐based bundles for care of postpartum hemorrhage (PPH). Methods An international technical consultation was conducted in 2017 to develop draft bundles of clinical interventions for PPH taken from the WHO's 2012 and 2017 PPH recommendations and based on the validated “GRADE Evidence‐to‐Decision” framework. Twenty‐three global maternal‐health experts participated in the development process, which was informed by a systematic literature search on bundle definitions, designs, and implementation experiences. Over a 6‐month period, the expert panel met online and via teleconferences, culminating in a 2‐day in‐person meeting. Results The consultation led to the definition of two care bundles for facility implementation. The “first response to PPH bundle” comprises uterotonics, isotonic crystalloids, tranexamic acid, and uterine massage. The “response to refractory PPH bundle” comprises compressive measures (aortic or bimanual uterine compression), the non‐pneumatic antishock garment, and intrauterine balloon tamponade (IBT). Advocacy, training, teamwork, communication, and use of best clinical practices were defined as PPH bundle supporting elements. Conclusion For the first response bundle, further research should assess its feasibility, acceptability, and effectiveness; and identify optimal implementation strategies. For the response to refractory bundle, further research should address pending controversies, including the operational definition of refractory PPH and effectiveness of IBT devices.

Item Type: Article
Additional Information: This is an open access article under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits use, distribution and reproduction in any medium, provided the original work is properly cited. © 2019 The Authors. International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.
Keywords: Aortic compression, Bimanual compression, Intrauterine balloon tamponade, Non-pneumatic antishock garment, Obstetric hemorrhage, Patient care bundles, Postpartum hemorrhage, Tranexamic acid, Uterotonics, Aortic compression, Bimanual compression, Intrauterine balloon tamponade, Non-pneumatic antishock garment, Obstetric hemorrhage, Patient care bundles, Postpartum hemorrhage, Tranexamic acid, Uterotonics, Aortic compression, Bimanual compression, Intrauterine balloon tamponade, Non-pneumatic antishock garment, Obstetric hemorrhage, Patient care bundles, Postpartum hemorrhage, Tranexamic acid, Uterotonics, 1114 Paediatrics and Reproductive Medicine, Obstetrics & Reproductive Medicine
SGUL Research Institute / Research Centre: Academic Structure > Molecular and Clinical Sciences Research Institute (MCS)
Journal or Publication Title: Int J Gynaecol Obstet
ISSN: 1879-3479
Language: eng
Dates:
DateEvent
4 February 2020Published
23 December 2019Published Online
8 November 2019Accepted
Publisher License: Creative Commons: Attribution 4.0
Projects:
Project IDFunderFunder ID
UNSPECIFIEDBill & Melinda Gates FoundationUNSPECIFIED
UNSPECIFIEDMassachusetts General Hospital Division of Global Health and Human RightsUNSPECIFIED
UNSPECIFIEDUNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of ResearchUNSPECIFIED
UNSPECIFIEDDevelopment and Research Training in Human Reproduction (HRP)UNSPECIFIED
UNSPECIFIEDWHOUNSPECIFIED
UNSPECIFIEDUjenzi Charitable TrustUNSPECIFIED
001World Health OrganizationUNSPECIFIED
PubMed ID: 31709527
Web of Science ID: WOS:000503989500001
Go to PubMed abstract
URI: http://openaccess.sgul.ac.uk/id/eprint/111415
Publisher's version: https://doi.org/10.1002/ijgo.13028

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