This thesis contributes to the area of postpartum haemorrhage. Massive haemorrhage protocol mhp queensland clinical guidelines. Postpartum hemorrhage pph blood loss in excess of 500 mls in. Postpartum haemorrhage pph is a major cause of maternal morbidity and mortality. Practice obstetrics committee and approved by the council of the sogc. The society of obstetricians and gynaecologists of canada has published a guideline on prevention and management of postpartum haemorrhage. Pdf an update on the risk factors for and management of. Table 3 of the sogc clinical practice guideline active management of the third stage of.
Grade a good evidence to recommend clinical preventative action. Postpartum hemorrhage remains the leading cause of maternal mortality worldwide and the main component of severe maternal morbidity in western countries. Primary postpartum haemorrhage linkedin slideshare. Drug management issues in amtsl, rpm plusmsh, 2004 section 2 creating access to misoprostol.
Who recommendations for the prevention of postpartum haemorrhage. Most women receive some type of prophylactic management, which may include pharmacological or nonpharmacological interventions. An update on the risk factors for and management of obstetric haemorrhage article pdf available in women s health 4. Prevention and management of postpartum haemorrhage 2017. Comparison of postpartum haemorrhage guidelines obstetrics and. Who recommendations for the prevention of postpartum haemorrhage 5 in contrast to active management, expectant management involves waiting for signs of separation and allowing the placenta to deliver spontaneously, or aided by gravity or nipple stimulation. I i get help local control bp and coagulation obstetriciansurgeon manual. Postpartum haemorrhage is the leading cause of maternal morbidity and mortality, but most cases of pph can be effectively prevented and treated in virtually all settings where women deliver. Prevention and management of postpartum haemorrhage. Rcog guideline prevention and management of postpartum.
Say l, chou d, gemmill a, tuncalp o, moller ab, daniels j, gulmezoglu am, temmerman m, alkema l. Maternity prevention, detection, escalation and management. Hospital harm improvement resource obstetric hemorrhage. Prevention and treatment of postpartum hemorrhage abstract objective. Guideline on the management of postpartum haemorrhage, hse. The prevention and treatment of postpartum haemorrhage. Postpartum haemorrhage, prevention and management greentop. May 25, 2017 rcog guideline prevention and management of postpartum haemorrhage no. Prevention and management of postpartum haemorrhage jogc. The evidencebased management of postpartum haemorrhage. International journal of gynecology and obstetrics 117 2012 108118. Prevention and management of postpartum hemorrhage.
Who recommendations for the prevention and treatment of postpartum haemorrhage 3 executive summary introduction postpartum haemorrhage pph is commonly defined as a blood loss of 500 ml or more within 24 hours after birth. Who guidelines for the management of postpartum haemorrhage and retained placenta 2 establish the cause of the haemorrhage, and possibly obtain the assistance of other care providers, such as an obstetrician, anaesthetist or radiologist. Who recommendations for the prevention of postpartum. Avoiding delays in diagnosis and treatment will have a significant impact on sequelae and chance of survival. The 2009 guideline was based on an earlier guideline on the management of postpartum haemorrhage pph developed in 1998 under the auspices of the scottish committee of the royal college of obstetricians and gynaecologists rcog and updated in 2002. This document represents the world health organization whos normative support for using evidenceinformed policies and practices. The search strategy used was misoprostol or cytotec or placebo, and rct or random or controlled trials, and prevention or treatment, and postpartum haemorrhage or pph. Postpartum hemorrhage is blood loss in excess of 500 ml after a vaginal birth and in excess of ml after a cesarean section delivery or any blood loss that has the potential to produce hemodynamic instability.
Postpartum haemorrhage is a direct cause of maternal death worldwide and usually occurs during the third stage of labour. Prevention and management of postpartum hemorrhage janice m. Jan 02, 2015 prevention and management of postpartum haemorrhage royal college of obstetricians and gynaecologists may 2009 with revisions april 2011 bjog figo guidelines. Who recommendations on prevention and treatment of postpartum haemorrhage. As the majority of pph cases are due to uterine atony 70% this guideline focuses on this cause.
Treatment of acquired coagulopathy observed in severe pph is an important part of pph management, but is mainly based on literature in trauma patients, and data thus should be interpreted with caution. Reference rcog guideline on prevention and management of postpartum hemorrhage rcog 2016 dec pdf society of obstetricians and gynaecologists of canada sogc grading system for recommendations. Prevention and management of postpartum hemorrhage american. A randomised control of carbetocin versus syntometrine in the management of third stage of labour. Prophylactic management of postpartum haemorrhage in the. This guideline is an update of the who recommendations for the prevention of postpartum haemorrhage pph published in 2007 and the who guidelines for the management of pph and retained placenta published in 2009. Who who recommendations on prevention and treatment of. Prevention and treatment of postpartum haemorrhage. Please see later in the article for the editors summary. Prevention and management of postpartum haemorrhage royal college of obstetricians and gynaecologists may 2009 with revisions april 2011 bjog figo guidelines. Identificationandassessmentofevidence this rcog guideline is based on an earlier guideline on the management of postpartum haemorrhagedevelopedin1998.
Some women will have risk factors for heavy bleeding, but most will not. The search was conducted irrespective of geographical region of the study. Mavrides e, allard s, chandraharan e, collins p, green l, hunt bj, riris s, thomson aj on behalf of the royal college of obstetricians and gynaecologists. Who recommendations on prevention and treatment of postpartum. Major postpartum haemorrhage has an incidence of 4% and contributes to nearly a quarter of all maternal deaths worldwide, 14 a figure that can be reduced significantly by effective management. Misoprostol for the treatment of postpartum haemorrhage in.
Postpartum haemorrhage, prevention and management greentop guideline no. National consensus guideline for treatment of postpartum. Although pharmacologic prevention of uterine atony in the third stage of labor significantly decreases the incidence of postpartum hemorrhage 5 and is now recommended in. Prevention and treatment of postpartum haemorrhage duration. Investing in improved midwifery and obstetric services remains vital for reducing maternal morbidity and mortality. Definitiona blood loss in excess of 500ml after a vaginal delivery, occurring in the first 24 hrs post partum. Prevention and treatment of postpartum hemorrhage in lowresource settings. Active man agement of the third stage of labor should be used routinely to reduce its incidence. The work in this thesis, including the publications, is collaboration between me and my supervisors. Rcog guideline prevention and management of postpartum haemorrhage no. Program implementation guidance postpartum hemorrhage. Clinical practice guideline prevention and management of. To provide secms with the best practice evidence on the prevention and management of postpartum haemorrhage. Pph is the leading cause of maternal mortality in lowincome countries and the primary cause of nearly one quarter of all.
Definition loss of blood more than 500 ml from the genital tract post delivery of a baby who excessive pvb that cause haematocrit drop more than 10% that require immediate transfusion acog 3. Uterine atony is the most common underlying condition leading to postpartum hemorrhage and robust evidence indicates that uterotonics used during the third stage of labor are effective in reducing postpartum bleeding. Guideline on the management of postpartum haemorrhage. This rcog guideline is based on an earlier guideline on the management of postpartum. Jun 27, 2016 postpartum haemorrhage pph is a major cause of maternal morbidity and mortality. Second line pharmacological agents for the treatment of primary. Obs cymru quality and safety sub group of maternity network wales. Full text full text is available as a scanned copy of the original print version. Prevention and management of postpartum haemorrhage green.
Postpartum hemorrhage is associated with onequarter of all maternal deaths and severe maternal morbidities in the world. Sogc clinical practice guideline active management of the third stage of labour. Misoprostol for prevention and treatment of postpartum. Patient summary heavy bleeding after a baby is born postpartum haemorrhage is a complication of pregnancy that has the potential to be very serious, even resulting in death in rare cases. All wales guideline prevention and management of postpartum. Search words includedpostpartum haemorrhage,factorvii,syntocinon. The prevention of postpartum hemorrhage in the community. Prevention and management of postpartum haemorrhage greentop guideline no. Prevention and treatment of postpartum haemorrhage a. Diagnosis and management of postpartum haemorrhage the bmj. Sogc clinical practice guideline 2000, prevention and management of. Postpartum haemorrhage is a major cause of death during pregnancy and early motherhood, accounting for 25% of maternal deaths worldwide,1 and is the second leading direct cause of maternal deaths in the uk.
The evidencebased management of postpartum haemorrhage this training course is based on the following guidelines. Postpartum hemorrhage is common and can occur in patients without risk factors for hemorrhage. Sep 27, 2017 postpartum haemorrhage is a major cause of death during pregnancy and early motherhood, accounting for 25% of maternal deaths worldwide,1 and is the second leading direct cause of maternal deaths in the uk. Mar 15, 2007 postpartum hemorrhage, the loss of more than 500 ml of blood after delivery, occurs in up to 18 percent of births and is the most common maternal morbidity in developed countries. Obstetric hemorrhage canadian patient safety institute. Who guidelines for the management of postpartum haemorrhage. Maternal deaths due to pph are rare in canada, occurring in approximately 30100 000 cases of. Postpartum hemorrhage is the leading cause of maternal death worldwide, with an estimated mortality rate of 140 000 per year, or one maternal death every four minutes. This guideline is adapted and updated from rcog guideline no. Prevention and management of post partum hemorrhage sogc. Metin gulmezoglu undpunfpawhoworld bank special programme of research, development and research training in human reproduction, geneva, switzerland training course in reproductive health research 2008.
However midwives should consider other possible causes of abnormal bleeding when approaching the management of pph. What are the risk factors for developing pph and how can they be minimised. Steps to availability, venture strategies for health and development, 2004. Primary postpartum haemorrhage refer to online version, destroy printed copies after use page 4 of 37 flow chart. Executive summary of recommendations prediction and prevention of pph. Prevention and management of postpartum haemorrhage journal. Postpartum haemorrhage, prevention and management green. Postpartum hemorrhage resulting from uterine atony after. Who recommendations for the prevention and treatment of.
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