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

Fernando Althabe, Michelle N.S. Therrien, Veronica Pingray, Jorge Hermida, Ahmet M. Gülmezoglu, Deborah Armbruster, Neelima Singh, Moytrayee Guha, Lorraine F. Garg, Joao P. Souza, Jeffrey M. Smith, Beverly Winikoff, Kusum Thapa, Emmanuelle Hébert, Jerker Liljestrand, Soo Downe, Ezequiel Garcia Elorrio, Sabaratnam Arulkumaran, Emmanuel K. Byaruhanga, David M. LissauerMonica Oguttu, Alexandre Dumont, Maria F. Escobar, Carlos Fuchtner, Pisake Lumbiganon, Thomas F. Burke, Suellen Miller

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)290-299
Number of pages10
JournalInternational Journal of Gynecology and Obstetrics
Issue number3
StatePublished - Mar 1 2020


  • Aortic compression
  • Bimanual compression
  • Intrauterine balloon tamponade
  • Non-pneumatic antishock garment
  • Obstetric hemorrhage
  • Patient care bundles
  • Postpartum hemorrhage
  • Tranexamic acid
  • Uterotonics

ASJC Scopus subject areas

  • Obstetrics and Gynecology


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