Management of Post-Partum Hemorrhage (Clinical Guideline)

Document Type : Guideline

Authors

1 Associate Professor, Department of Obstetrics and Gynecology, Ovulation Dysfunction Research Center, Patient Safety Research Center, Patient Safety Clinical Knowledge Management Unit, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

2 General Practitioner, MPH, Patient Safety Research Center, Patient Safety Clinical Knowledge Management Unit, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

3 Associate Professor, Department of Obstetrics and Gynecology, Ovulation Dysfunction Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

4 Assistant Professor, Department of Obstetrics and Gynecology, Ovulation Dysfunction Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

5 General Practitioner, Patient Safety Research Center, Patient Safety Clinical Knowledge Management Unit, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

6 Assistant Professor, Department of Community Medicine, Patient Safety Research Center, Patient Safety Clinical Knowledge Management Unit, Mashhad University of Medical Sciences, Mashhad, Iran.

7 Professor, Department of Obstetrics and Gynecology, Tabriz University of Medical Sciences, Tabriz, Iran.

8 Professor, Department of Obstetrics and Gynecology, Tehran University of Medical Sciences, Tehran, Iran.

9 Associate Professor, Department of Obstetrics and Gynecology, Shiraz University of Medical Sciences, Shiraz, Iran.

10 Professor, Department of Obstetrics and Gynecology, Esfahan University of Medical Sciences, Esfahan, Iran.

11 General Practitioner, Research Center for Patient Safety, Patient Safety Clinical Knowledge Management Unit, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

Abstract

Introduction: The complexity of the diagnostic process and the therapeutic options as well as the continuing difficulties in the management of postpartum hemorrhage and lack of a unified national guideline, lead the group to prepare a comprehensive guideline in this field to improve morbidity and prognosis.
Methods: We searched electronically all resources for postpartum hemorrhage guidelines. We used the AGREE criteria to recognize high quality guidelines. The highest rates for the prevention and management of postpartum hemorrhage Guidelines were for Royal College of Obstetricians and Gynecologists Guidelines (2009), WHO guidelines (2009) and Institute of Obstetricians and Gynecologists Royal College of Physicians of Ireland (2012). The expert clinicians in content area produced a table to compare each guideline recommendations. We prepared a second table to record extracted information from articles and all important outcomes and the level of evidence, also we used checklists for quality evaluation of each study with different type. In addition the potential benefits and harms of interventions and the cost price were considered. These forms were presented to the expert panel and after using the appraisal instrument and comparing the content of recommendations and the level of supporting evidences; the group decided which recommendations should be justified for local use and the final judgment was taken whether the recommendation is valid or applicable to local conditions and individual patients.
Results: Finally the recommendations were matched and the best or most appropriate and executable were adopted and repackaged into the new local guideline. For instant: Prophylactic oxytocics should be offered routinely in the management of the third stage of labor as they reduce the risk of PPH by about 60%.
 

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