TY - JOUR
T1 - Postpartum hemorrhage care bundles to improve adherence to guidelines : a WHO technical consultation
AU - Althabe, Fernando
AU - Therrien, Michelle N. S.
AU - Pingray, Veronica
AU - Hermida, Jorge
AU - Gülmezoglu, Ahmet M.
AU - Armbruster, Deborah
AU - Singh, Neelima
AU - Guha, Moytrayee
AU - Garg, Lorraine F.
AU - Souza, Joao P.
AU - Smith, Jeffrey M.
AU - Winikoff, Beverly
AU - Thapa, Kusum
AU - Hébert, Emmanuelle
AU - Liljestrand, Jerker
AU - Downe, Soo
AU - Garcia Elorrio, Ezequiel
AU - Arulkumaran, Sabaratnam
AU - Byaruhanga, Emmanuel K.
AU - Lissauer, David M.
AU - Oguttu, Monica
AU - Dumont, Alexandre
AU - Escobar, Maria F.
AU - Fuchtner, Carlos
AU - Lumbiganon, Pisake
AU - Burke, Thomas F.
AU - Miller, Suellen
PY - 2020
Y1 - 2020
N2 - 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.
AB - 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.
UR - https://hdl.handle.net/1959.7/uws:64088
U2 - 10.1002/ijgo.13028
DO - 10.1002/ijgo.13028
M3 - Article
SN - 0020-7292
VL - 148
SP - 290
EP - 299
JO - International Journal of Gynecology and Obstetrics
JF - International Journal of Gynecology and Obstetrics
IS - 3
ER -
