Details

Autor(en) / Beteiligte

• Pingray, Verónica
• Williams, Caitlin R
• Al-beity, Fadhlun M Alwy
• Abalos, Edgardo
• Arulkumaran, Sabaratnam
• Blumenfeld, Alejandro
• Carvalho, Brendan
• Deneux-Tharaux, Catherine
• Downe, Soo
• Dumont, Alexandre
• Escobar, Maria Fernanda
• Evans, Cherrie
• Fawcus, Sue
• Galadanci, Hadiza S
• Hoang, Diem-Tuyet Thi
• Hofmeyr, G Justus
• Homer, Caroline
• Lewis, Ayodele G
• Liabsuetrakul, Tippawan
• Lumbiganon, Pisake
• Main, Elliott K
• Maua, Judith
• Muriithi, Francis G
• Nabhan, Ashraf Fawzy
• Nunes, Inês
• Ortega, Vanesa
• Phan, Thuan N Q
• Qureshi, Zahida P
• Sosa, Claudio
• Varallo, John
• Weeks, Andrew D
• Widmer, Mariana
• Oladapo, Olufemi T
• Gallos, Ioannis
• Coomarasamy, Arri
• Miller, Suellen
• Althabe, Fernando

Titel

Strategies for optimising early detection and obstetric first response management of postpartum haemorrhage at caesarean birth: a modified Delphi-based international expert consensus

Ist Teil von

• BMJ open, 2024-05, Vol.14 (5), p.e079713-e079713

Ort / Verlag

England: British Medical Journal Publishing Group

Erscheinungsjahr

2024

Link zum Volltext

Quelle

Free E-Journal (出版社公開部分のみ）

Beschreibungen/Notizen

• ObjectiveThere are no globally agreed on strategies on early detection and first response management of postpartum haemorrhage (PPH) during and after caesarean birth. Our study aimed to develop an international expert’s consensus on evidence-based approaches for early detection and obstetric first response management of PPH intraoperatively and postoperatively in caesarean birth.DesignSystematic review and three-stage modified Delphi expert consensus.SettingInternational.PopulationPanel of 22 global experts in PPH with diverse backgrounds, and gender, professional and geographic balance.Outcome measuresAgreement or disagreement on strategies for early detection and first response management of PPH at caesarean birth.ResultsExperts agreed that the same PPH definition should apply to both vaginal and caesarean birth. For the intraoperative phase, the experts agreed that early detection should be accomplished via quantitative blood loss measurement, complemented by monitoring the woman’s haemodynamic status; and that first response should be triggered once the woman loses at least 500 mL of blood with continued bleeding or when she exhibits clinical signs of haemodynamic instability, whichever occurs first. For the first response, experts agreed on immediate administration of uterotonics and tranexamic acid, examination to determine aetiology and rapid initiation of cause-specific responses. In the postoperative phase, the experts agreed that caesarean birth-related PPH should be detected primarily via frequently monitoring the woman’s haemodynamic status and clinical signs and symptoms of internal bleeding, supplemented by cumulative blood loss assessment performed quantitatively or by visual estimation. Postoperative first response was determined to require an individualised approach.ConclusionThese agreed on proposed approaches could help improve the detection of PPH in the intraoperative and postoperative phases of caesarean birth and the first response management of intraoperative PPH. Determining how best to implement these strategies is a critical next step.