Background
Methods
Indicator development procedure
Step 1: composing an expert panel
Step 2: literature research and collection of possible indicators
Step 3: questionnaire
Step 4: consensus meeting
Step 5: critical evaluation
Results
Step 1
Step 2
Step 3
Step 4
Step 5
Median (n)
| Agreement (% of panellists with score of 7, 8 or 9) | ||
---|---|---|---|
For prevention of PPH, the midwife should;
| |||
1 | Antenatally: identify elevated- or high risk of PPH and agree on preventive strategies*.†
| 8.5 (12)
| 100 |
2 | At birth: identify elevated- or high risk of PPH and agree (or adjust) preventive strategies*.†
| 8 (12)
| 100 |
3 | If high risk of PPH is assessed: have birth occur in hospital supervised by the obstetrician. †
| 8.5 (12)
| 100 |
4 | Routinely administer uterotonics (at least 5 IU oxytocin intramuscular). †
| 9 (12)
| 83,3 |
In case of blood loss >500 mL, without signs of shock the midwife should;
| |||
5 | Measuring blood loss by weighing. †
| 9 (12)
| 91,6 |
6 | Homebirth: in case of retained placenta; refer to secondary care after 30 minutes | 9 (13)
| 92,3 |
7 | Midwifery supervised hospital birth: in case of retained placenta; refer to secondary care after 30 minutes | 9 (13)
| 75 |
8 | Homebirth: if blood loss is not ceasing, refer to secondary care. †
| 9 (12)
| 83,4 |
9 | Midwifery supervised hospital birth: if blood loss is not ceasing, refer to secondary care. †
| 9 (12)
| 83,3 |
10 | Treat PPH as uterine atony (and apply bladder catheterization, uterine massage and oxytocin) until proven otherwise. | 9 (13)
| 100 |
11 | Post placental: if blood loss is not ceasing despite administration of uterotonics, examine for vaginal and perineal lesions. †
| 7 (12)
| 75 |
In case of PPH of >1000 mL and/or signs of shock, the midwife should;
| |||
12 | Inform the secondary caregiver (obstetrician). | 9 (13)
| 100 |
13 | Start an intravenous line and supply with fluids, using 0, 9% sodium chloride. | 8 (13)
| 100 |
14 | Monitor vital signs frequently (pulse, blood pressure, respiratory frequency). | 8 (13)
| 92,4 |
15 | Regardless of oxygen saturation, provide patient with 10–15 litre oxygen via non-rebreathing mask. | 9 (13)
| 84,6 |
In case of PPH of > 1000 mL with signs of shock and/or >2000 mL blood loss the midwife should;
| |||
16 | In case of persisting haemorrhage with signs of shock, perform uterine and/ or aortal compression. †
| 8 (12)
| 83,3 |
17 | Secure a second intravenous line (14 gauge). | 9 (13)
| 79,9 |
18 | If the patient has reduced consciousness due to hypovolemic shock, call for (paramedic) assistance in order to establish an open airway. | 9 (13)
| 83,4 |
19 | Immediately transfer patient to secondary care. †
|
(12) Added in second round | 100 |
Concerning cooperation and training;
| |||
20 | Within every regional obstetric collaboration£ a regional PPH protocol should be present, based on national guidelines. | 9 (13)
| 91,7 |
21 | A regional PPH protocol should be the basis of regular audits. | 9 (13)
| 83,3 |
22 | The midwife is aware that ambulance transportation in case of PPH or retained placenta is always of the highest urgency category. | 9 (13)
| 91,7 |
23 | After each PPH with >2000 mL blood loss, the multidisciplinary team should debrief the situation. | 8 (13)
| 83,4 |
24 | Within the regional obstetric collaboration£ an annual training in obstetric emergencies should be provided. | 9 (13)
| 100 |
25 | In a homebirth situation, anticipation on possible ambulance transport is necessary; make sure the patient is at an accessible place for (all) caregivers in time. | 9 (13)
| 100 |