TY - JOUR
T1 - Postpartum hemorrhage care bundles to improve adherence to guidelines
T2 - 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
N1 - Funding Information:
Funding was provided by the Bill & Melinda Gates Foundation, Massachusetts General Hospital Division of Global Health and Human Rights, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), WHO, and the Ujenzi Charitable Trust. Thank you also to Justus Hofmyer for his participation in technical consultations.
Publisher Copyright:
© 2019 The Authors. International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics
PY - 2020/3/1
Y1 - 2020/3/1
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.
KW - Aortic compression
KW - Bimanual compression
KW - Intrauterine balloon tamponade
KW - Non-pneumatic antishock garment
KW - Obstetric hemorrhage
KW - Patient care bundles
KW - Postpartum hemorrhage
KW - Tranexamic acid
KW - Uterotonics
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U2 - 10.1002/ijgo.13028
DO - 10.1002/ijgo.13028
M3 - Article
C2 - 31709527
AN - SCOPUS:85076924117
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 -