Dataset Information

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

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.

SUBMITTER: Althabe F

PROVIDER: S-EPMC7064978 | biostudies-literature | 2020 Mar

REPOSITORIES: biostudies-literature

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Publications

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

Althabe Fernando F Therrien Michelle N S MNS Pingray Veronica V Hermida Jorge J Gülmezoglu Ahmet M AM Armbruster Deborah D Singh Neelima N Guha Moytrayee M Garg Lorraine F LF Souza Joao P JP Smith Jeffrey M JM Winikoff Beverly B Thapa Kusum K Hébert Emmanuelle E Liljestrand Jerker J Downe Soo S Garcia Elorrio Ezequiel E Arulkumaran Sabaratnam S Byaruhanga Emmanuel K EK Lissauer David M DM Oguttu Monica M Dumont Alexandre A Escobar Maria F MF Fuchtner Carlos C Lumbiganon Pisake P Burke Thomas F TF Miller Suellen S

International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 20191223 3

<h4>Objective</h4>To systematically develop evidence-based bundles for care of postpartum hemorrhage (PPH).<h4>Methods</h4>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 sea ...[more]

PMID: 31709527

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Project description:BackgroundDespite the introduction of evidence based guidelines and practical courses, the incidence of postpartum hemorrhage shows an increasing trend in developed countries. Substandard care is often found, which implies an inadequate implementation in high resource countries. We aimed to reduce the gap between evidence-based guidelines and clinical application, by developing a strategy, tailored to current barriers for implementation.MethodsThe development of the implementation strategy consisted of three phases, supervised by a multidisciplinary expert panel. In the first phase a framework of the strategy was created, based on barriers to optimal adherence identified among professionals and patients together with evidence on effectiveness of strategies found in literature. In the second phase, the tools within the framework were developed, leading to a first draft. In the third phase the strategy was evaluated among professionals and patients. The professionals were asked to give written feedback on tool contents, clinical usability and inconsistencies with current evidence care. Patients evaluated the tools on content and usability. Based on the feedback of both professionals and patients the tools were adjusted.ResultsWe developed a tailored strategy to improve guideline adherence, covering the trajectory of the third trimester of pregnancy till the end of the delivery. The strategy, directed at professionals, comprehending three stop moments includes a risk assessment checklist, care bundle and time-out procedure. As patient empowerment tools, a patient passport and a website with patient information was developed. The evaluation among the expert panel showed all professionals to be satisfied with the content and usability and no discrepancies or inconsistencies with current evidence was found. Patients' evaluation revealed that the information they received through the tools was incomplete. The tools were adjusted accordingly to the missing information.ConclusionA usable, tailored strategy to implement PPH guidelines and practical courses was developed. The next step is the evaluation of the strategy in a feasibility trial.Trial registrationClinical trial registration: The Fluxim study, registration number: NCT00928863 .

Project description:BackgroundIn 2018, the American College of Obstetricians and Gynecologists (ACOG) issued multiple recommendations to optimize care within the first 12 weeks postpartum. We explored the extent to which clinicians follow ACOG's recommendations at the first postpartum visit and identified factors associated with overall adherence to clinical recommendations.MethodsBetween September 2023 and February 2024, we collected data from an online survey about the care practices of 174 obstetric clinicians practicing in California. The response rate was 76%. Adherence was measured by asking the extent to which clinicians always complete care components drawn from a list of 26 of ACOG's clinical recommendations. We used descriptive statistics and ran linear regression models to quantify the association between adherence to guidelines and years of clinical practice, proportion of patients utilizing Medi-Cal, the method of reimbursement received by the provider, perceived organizational, financial and patient barriers, duration of the visit and number of collaborations with other providers.ResultsThe median percentage of components checked by clinicians was 62%. Significantly higher adherence was found among clinicians with at least 12 years of practice compared with those with approximately 5 years or less and among clinicians who collaborated with 5 or more multidisciplinary providers versus fewer than 3. Adherence was also higher among clinicians who on average spent at least 30 min vs. less than 20 min with their patients and those who perceived high financial barriers to care among their patients. In contrast, clinicians who served highly mixed practices of Medi-Cal and non-Medi-Cal recipients reported lower adherence.ConclusionWe sought to understand which clinicians were more able to align their practice with ACOG guidelines at the first postpartum visit. We found that more experienced clinicians, those who simplified their practices to either all Medi-Cal or few Medi-Cal recipients, and those who collaborated more with other providers from various disciplines were best able to provide the care recommended in the guidelines. Our findings highlight where policy, resources and training are needed to improve guideline adherence and whole person care.

Project description:BackgroundThe immediate postpartum period is the most critical time for both the mother and the newborn. However, it is the most neglected part of the maternal continuum of care, and evidence in this regard was scarce in Ethiopia. Therefore, this study aimed to assess the healthcare provider's adherence to immediate postpartum care guidelines and associated factors in hospitals of Gondar province.MethodsA multicenter observational cross-sectional study was conducted among 406 healthcare providers from 15th November 2020 to 10th March 2021. Data were collected through face-to-face interviews and direct observation using a structured questionnaire and standardized checklist respectively. Data was entered into EPI INFO 7.1.2 and analyzed by SPSS version 25. Both bivariable and multivariable logistic regression analyses were carried out. The level of significance was declared based on the adjusted odds ratio (AOR) with a 95% confidence interval (CI) at a p-value of ≤ 0.05.ResultsOverall, 42.4% (95% CI: 37.5, 47.2) of healthcare providers had complete adherence to immediate postpartum care guidelines. Having birth assistant (AOR = 1.87; 95% CI: 1.10, 9.67), being married (AOR = 1.59; 95% CI: 1.15, 3.31), availability of postpartum care guidelines at the maternity ward (AOR = 2.39; 95% CI: 1.44, 3.98), received basic emergency obstetric and newborn care (BEmONC) training (AOR = 2.1; 95% CI: 1.2, 3.6), monthly income of ≥ 10001 Ethiopian birr (AOR = 3.55; 95% CI: 1.30, 9.67), and work experience of ≥ 6 years (AOR = 0.15; 95% CI: 0.06, 0.38) were significantly associated with healthcare providers adherence to immediate postpartum care guidelines.ConclusionThis study indicated that health worker's adherence to immediate postpartum care guidelines was low. Hiring adequate health workers, availing postpartum guidelines at the maternity ward, improving the salary and education opportunities for healthcare workers of healthcare workers, and provision of BEmONC training will have a great role in improving healthcare provider's adherence to immediate postpartum care guidelines.

Project description:BackgroundDuring the postpartum visit, health care providers address issues with short- and long-term implications for maternal and child health. Women with Medicaid insurance are less likely to return for a postpartum visit compared with women with private insurance. Behavioral economics acknowledges that people do not make exclusively rational choices, rather immediate gratification, cognitive and psychological biases, and social norms influence decision making. Drawing on insights from decision science, behavioral economists have examined how these biases can be modulated through carefully designed interventions. We have developed a Web-based tool, Healthy Beyond Pregnancy, that incorporates empirically derived concepts of behavioral economics to improve adherence rates to the postpartum visit.ObjectivesThe primary objectives of this pilot study were to (1) refine and assess the usability of Healthy Beyond Pregnancy and (2) assess the feasibility of a randomized controlled trial (RCT) of the intervention.MethodsWe used a multistep process and multidisciplinary team of maternal-fetal medicine physicians, a behavioral economist, and researchers with expertise in behavioral interventions to design Healthy Beyond Pregnancy. We assessed the usability of the program with the Post-Study System Usability Questionnaire (PSSUQ), a validated 7-point scale, and semistructured interviews with postpartum women. We then conducted a feasibility trial to determine the proportion of eligible women who were willing to participate in an RCT of Healthy Beyond Pregnancy and the proportion of women willing to complete the Web-based program. Exploratory outcomes of the pilot trial included attendance at the postpartum visit, uptake of long-acting reversible contraception, and uptake of any contraception.ResultsThe median PSSUQ score for Healthy Beyond Pregnancy was 6.5 (interquartile range: 6.1-7) demonstrating high usability. Semistructured interviews (n=10) provided in-depth comments about users' experience and further improved the program. A total of 34 postpartum women with Medicaid insurance were approached for the pilot trial, and 30 (88%) were consented and randomized. All women randomized to Healthy Beyond Pregnancy completed the Web-based program, had text-enabled cell phones, and were willing to receive text messages from the study team. Women in the Healthy Beyond Pregnancy arm were more likely to return for a postpartum visit compared with women in the control arm with 85% of women in Healthy Beyond Pregnancy returning versus 53% in the control arm (odds ratio in the Healthy Beyond Pregnancy group: 5.3; 95% CI 0.9-32.0; P=.06).ConclusionsWe have developed a highly usable and acceptable Web-based program designed to increase attendance at the postpartum visit. Our pilot trial demonstrates that women are willing and able to participate in a randomized trial of a Web-based program and text messaging system.Trial registrationClinicaltrials.gov NCT03296774; https://clinicaltrials.gov/ct2/show/NCT03296774 (Archived by WebCite at http://www.webcitation.org/6tpgXFzyk).

Project description:BackgroundPostpartum hemorrhage is a leading cause of maternal morbidity and mortality in the United States and disproportionately affects pregnant persons of color.ObjectiveThis study aimed to identify the demographic and obstetrical characteristics of those who received different levels of antihemorrhagic intervention in the setting of severe postpartum hemorrhage requiring blood transfusion.Study designThis was a retrospective cohort study of patients with documented postpartum hemorrhage (estimated blood loss of ≥1000 mL) and blood product transfusion. Moreover, 3 levels of antihemorrhagic intervention were defined as follows: level 1, administration of uterotonics only; level 2, performance of a procedure (ie, B-Lynch suture, O'Leary stitch, Bakri balloon, dilation and curettage, laceration repair, or embolization); and level 3, hysterectomy. Maternal demographics, obstetrical characteristics, and comorbidities were extracted from electronic health records. Ordinal logistic regression was used to estimate the odds of higher intervention levels adjusting for maternal demographic and obstetrical characteristics.ResultsOf note, 365 patients were included in this study, with a racial or ethnic composition of 30% White, 42% Black, 18% Hispanic, and 10% other. Moreover, 233 patients (64%) received level 1 intervention, 98 patients (27%) received level 2 intervention, and 34 patients (9%) received level 3 intervention. Patients receiving higher levels of intervention were more likely to have greater estimated blood loss (P<.001), have more transfusions (P<.001), and be of advanced maternal age (P=.004). Black and Hispanic patients were less likely to have received higher levels of intervention than White patients (P=.034). After adjusting for estimated blood loss, advanced maternal age, placenta accreta spectrum, and fibroids, Black patients remained significantly less likely to receive higher levels of intervention (adjusted odds ratio, 0.55; 95% confidence interval, 0.30-0.98). This difference persisted at an estimated blood loss of ≥3000 mL, with Black and Hispanic patients being significantly less likely to receive higher levels of intervention than White patients (odds ratio, 0.31 [95% confidence interval, 0.10-0.92] and 0.10 [95% confidence interval, 0.01-0.53], respectively).ConclusionAmong patients experiencing postpartum hemorrhage and receiving transfusion, Black patients are less likely to receive higher levels of antihemorrhagic intervention. This disparity is concerning in this high-risk population and requires further attention and investigation.

Dataset Information

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

Objective

Methods

Results

Conclusion

Publications

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

Similar Datasets

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