Maternity and Neonatal Clinical Guideline
Supplement: Primary postpartum haemorrhage
uide.medlive.cn
Queensland Clinical Guideline Supplement: Primary postpartum haemorrhage
Table of Contents
1 Introduction.....................................................................................................................................31.1 Funding..................................................................................................................................31.2 Conflict of interest ............ ......................................................................................................31.3 Guideline review ............................................ ........................................................................32 Methodology...................................................................................................................................42.1 Topic identification ........... ......................................................................................................42.2 Scope ....................................................... ..............................................................................42.3 Clinical questions...................................................................................................................42.4 Exclusions..............................................................................................................................41.1 Search strategy ..................... .................................................................................................51.2 Consultation...........................................................................................................................51.3 Endorsement ............................ .............................................................................................51.4 Publication.............................................................................................................................53 Levels of evidence ...................... ....................................................................................................63.1 Summary recommendations ....................................... ...........................................................64 Implementation ............................................................................................ ...................................94.1 Guideline resources...............................................................................................................94.2 Suggested resources ................................ .............................................................................94.3 Implementation measures.....................................................................................................94.3.1 Queensland Clinical Guidelines measures .............................................. ..........................94.3.2 Hospital and Health Service measures .............................................................................94.4 Clinical quality measures .....................................................................................................105 References ...................................................................................................................................11List of Tables
Table 1. Summary of change ...............................................................................................................3Table 2. PICO Framework....................................................................................................................4Table 3. Major guideline development processes ................................. ...............................................5Table 4. Levels of evidence ..................................................................................................................6Table 5. Summary recommendations ...................................................................................................6© State of Queensland (Queensland Health) 2017
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guide.medlive.cnQueensland Clinical Guideline Supplement: Primary postpartum haemorrhage
1Introduction
This document is a supplement to the Queensland Clinical Guideline Primary postpartum haemorrhage (PPH). It provides supplementary information regarding guideline development, makes summary recommendations, suggests measures to assist implementation and quality activities and summarises changes (if any) to the guideline since original publication. Refer to the guideline for abbreviations, acronyms, flow charts and acknowledgements.
1.1Funding
The development of this guideline was supported with funding from Queensland Health, Centre for Healthcare Improvement. The Clinical Lead and Working Party participated on a voluntary basis. The consumer representative on the Steering Committee was paid a sitting fee.
1.2Conflict of interest
Declarations of Conflict of Interest were sought from working party members as per the Queensland Clinical Guidelines
Conflict of Interest statement. No conflict of interest was identified.
1.3Guideline review
The Queensland Clinical Guidelines are reviewed every 5 years or earlier if significant new evidence emerges.
Table 1 provides a summary of changes made to the guidelines since original publication.
Table 1. Summary of change
Date
Identifier
Summary of major change
02/07/2009
MN0907.1-V1-R11
First publication
22/08/2011
MN09.1-V2-R11
New website: updated name and format changes
07/12/2012
MN12.1-V3-R17
First full review original guideline
Flow charts amended/added:
o
Initial response
o
Massive transfusion protocol
o Emergency donor panel activation
Supplement added
14/10/2013
MN12.1-V4-R17
Rebranded with Queensland Government logo
Definition of terms: Added PRIME
Flow chart: Emergency donor panel activation: Target
results: ‘Base excess < minus="">, amended to ‘Base
excess > minus 6’
Section 3.2 Monitoring in the fourth stage of labour;
Table 5 Recommended observations post birth:
o Removed Normal birth column
o Added oxygen saturation and level of
consciousness to observations (as per National
consensus statement: essential elements for
recognising and responding to clinical
deterioration
1 ) Section 4.1 Tone: Carboprost information moved to
Section4.1.2
Section 4.1.2 Uterine atonia and second line drugs: New
section, Dinoprost added as Carboprost not readily
obtainable within Australia
Section 4.4 Thrombin; Table 15 Coagulopathy; Row
Coagulopathy correction; 3rd bullet point: deleted ‘refer
to Table 4’
15/03/2017
MN12.1-V5-R17
Section 4.1.2 and Flowchart–initial response: Clarified
administration instructions for Carboprost
Oxytocin infusion regimen updated from 40 IU in 1 L IV
solution to 30 IU in 500 mL IV solution to align with
Induction of labour clinical guideline
Minor formatting/branding updates
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guide.medlive.cnQueensland Clinical Guideline Supplement: Primary postpartum haemorrhage
2Methodology
Queensland Clinical Guidelines follows a rigorous process of guideline development. This process was endorsed by the Queensland Health Patient Safety and Quality Executive Committee in December 2009. The guidelines are best described as 'evidence informed consensus guidelines' and draw from the evidence base of existing national and international guidelines and the expert opinion of the working party.
2.1Topic identification
The topic was identified as a priority by the Statewide Maternity and Neonatal Clinical Network at a statewide forum in November 2008.
2.2Scope
The scope of the guideline was determined using the PICO (Population, intervention, comparison and outcome) Framework as outlined in
Table 2.Table 2. PICO Framework
PICO
Population
Gravid women
Intervention
Identify best practice methods for diagnosing PPH and defining a ‘severe’
PPH
Identify who is at risk and what measures can be taken to reduce the risk or
severity of PPH
Identify best practice for the first clinical response to PPH, including
maternal assessment, resuscitation and stabilisation
Identify best practice to treat the four causes of PPH i.e. uterine atonia,
trauma, tissue retention and coagulopathy
Identify best practice for management of massive blood loss
Identify best practice for a woman’s postnatal care and follow up after
experiencing a PPH
Comparison
N/A
Outcome
Women receive best practice care in pregnancy, labour and after birth to
reduce the incidence or severity of PPH
Women receive best practice assessment, resuscitation and treatment in the
event of PPH to minimise postnatal morbidity and/or mortality
Women receive best practice postnatal care and follow up to optimise
postnatal adaptation and minimise hospital length of stay
2.3Clinical questions
The following clinical questions were generated to inform the guideline scope and purpose:
· Are some women at greater risk of PPH?
· What is best practice for assessment, resuscitation and treatment of a woman experiencing PPH?
· What is best practice postnatal care and follow up for a woman recovering from PPH?
· Can risk reduction measures be used to prevent or reduce severity of PPH?
2.4Exclusions
The following exclusions were identified in the guideline scope:
· Step by step instructions for surgical techniques required to treat retractable PPH
· Definition, diagnosis and treatment of secondary postpartum haemorrhage
· Assessment and treatment of puerperal genital haematoma (refer to Guideline: Perineal Care)
· Emergency Donor Panel formulation and functioning
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