Prevention and management of postpartum hemorrhage: a comparison of 4 national guidelines.
American Journal of Obstetrics and Gynecology · 2015-02-28 · Guideline / consensus
Abstract
OBJECTIVE: The purpose of this study was to compare 4 national guidelines for the prevention and management of postpartum hemorrhage (PPH). STUDY DESIGN: We performed a descriptive analysis of guidelines from the American College of Obstetrician and Gynecologists practice bulletin, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, the Royal College of Obstetrician and Gynaecologists (RCOG), and the Society of Obstetricians and Gynaecologists of Canada on PPH to determine differences, if any, with regard to definitions, risk factors, prevention, treatment, and resuscitation. RESULTS: PPH was defined differently in all 4 guidelines. Risk factors that were emphasized in the guidelines conferred a high risk of catastrophic bleeding (eg, previous cesarean delivery and placenta previa). All organizations, except the American College of Obstetrician and Gynecologists, recommended active management of the third stage of labor for primary prevention of PPH in all vaginal deliveries. Oxytocin was recommended universally as the medication of choice for PPH prevention in vaginal deliveries. The Royal Australian and New Zealand College of Obstetricians and Gynaecologists and RCOG recommended development of a massive transfusion protocol to manage PPH resuscitation. Recommendations for nonsurgical treatment strategies such as uterine packing and balloon tamponade varied across all guidelines. All organizations recommended transfer to a tertiary care facility for suspicion of abnormal placentation. Specific indications for hysterectomy were not available in any guideline, with RCOG recommending hysterectomy "sooner rather than later" with the assistance of a second consultant. CONCLUSION: Substantial variation exists in PPH prevention and management guidelines among 4 national organizations that highlights the need for better evidence and more consistent synthesis of the available evidence with regard to a leading cause of maternal death.
Abstract © the authors or publisher, via PubMed. Reuse and removal
Tags
Blood products · Fluids & blood · Other drugs · Oxytocin
Related articles
- Guideline No. 431: Postpartum Hemorrhage and Hemorrhagic Shock. (J Obstet Gynaecol Can, 2022)
- Postpartum Hemorrhage: A Comprehensive Review of Guidelines. (Obstet Gynecol Surv, 2022)
- Postpartum hemorrhage: guidelines for clinical practice from the French College of Gynaecologists and Obstetricians (CNGOF): in collaboration with the French Society of Anesthesiology and Intensive Care (SFAR). (Eur J Obstet Gynecol Reprod Biol, 2016)
- Amniotic fluid embolism: diagnosis and management. (Am J Obstet Gynecol, 2016)
- International Guidelines for Neonatal Resuscitation: An excerpt from the Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: International Consensus on Science. Contributors and Reviewers for the Neonatal Resuscitation Guidelines. (Pediatrics, 2000)
- Inhospital coagulation management and fluid replacement therapy in patients with multiple and/or severe injuries - a systematic review and clinical practice guideline update. (Eur J Trauma Emerg Surg, 2025)