TY - JOUR
T1 - Clinical algorithms for management of third stage abnormalities
AU - Marcus, J K
AU - Fawcus, S
N1 - Funding Information:
This work was funded by the Bill & Melinda Gates Foundation (Grant #OPP1084318), The United States Agency for International Development (USAID) and the UNDP‐UNFPA‐UNICEF‐WHO‐World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), a co‐sponsored programme executed by the World Health Organization (WHO). The funders had no role in the design, data collection and analysis, decision to publish or preparation of the manuscript.
Publisher Copyright:
© 2022 John Wiley & Sons Ltd.
PY - 2024/8
Y1 - 2024/8
N2 - AIMS: To develop algorithms for identifying, managing and monitoring postpartum haemorrhage (PPH) and other third stage of labour abnormalities after vaginal delivery.POPULATION: Women with low-risk singleton term pregnancies who have had a vaginal delivery.SETTING: Hospital settings with a particular focus on healthcare facilities in low- and middle-income countries (LMICs).SEARCH STRATEGY: Searches for international and national guidance documents, research databases (Cochrane, Medline and CINAHL) and published systematic reviews. Searches were limited to work published in English between 1 January 2008 and 31 December 2018.CASE SCENARIOS: Four interlinked case scenarios were identified for algorithm development: (1) an approach to PPH after vaginal delivery, (2) uterine atony, (3) genital tract trauma and (4) retained placenta/placental products.CONCLUSIONS: The development of clear approaches to the assessment, resuscitation, treatment and monitoring of the four case scenarios are presented as algorithms, based on available evidence. They need to be field tested and evaluated for effectiveness, and may be adapted for electronic decision support tools using artificial intelligence in different settings. Further research is needed around multimodal sequential packages of care for PPH, conservative surgical measures, resuscitation in LMICs, and how a respectful maternity care focus can be incorporated into the algorithms.TWEETABLE ABSTRACT: Algorithm development for standardised approaches to managing PPH in low-resource settings.
AB - AIMS: To develop algorithms for identifying, managing and monitoring postpartum haemorrhage (PPH) and other third stage of labour abnormalities after vaginal delivery.POPULATION: Women with low-risk singleton term pregnancies who have had a vaginal delivery.SETTING: Hospital settings with a particular focus on healthcare facilities in low- and middle-income countries (LMICs).SEARCH STRATEGY: Searches for international and national guidance documents, research databases (Cochrane, Medline and CINAHL) and published systematic reviews. Searches were limited to work published in English between 1 January 2008 and 31 December 2018.CASE SCENARIOS: Four interlinked case scenarios were identified for algorithm development: (1) an approach to PPH after vaginal delivery, (2) uterine atony, (3) genital tract trauma and (4) retained placenta/placental products.CONCLUSIONS: The development of clear approaches to the assessment, resuscitation, treatment and monitoring of the four case scenarios are presented as algorithms, based on available evidence. They need to be field tested and evaluated for effectiveness, and may be adapted for electronic decision support tools using artificial intelligence in different settings. Further research is needed around multimodal sequential packages of care for PPH, conservative surgical measures, resuscitation in LMICs, and how a respectful maternity care focus can be incorporated into the algorithms.TWEETABLE ABSTRACT: Algorithm development for standardised approaches to managing PPH in low-resource settings.
KW - Algorithms
KW - emergency obstetric care
KW - low- and middle-income countries
KW - low-resource settings
KW - management
KW - postpartum haemorrhage
KW - prevention
KW - Sub-Saharan Africa
UR - http://www.scopus.com/inward/record.url?scp=85133554867&partnerID=8YFLogxK
U2 - 10.1111/1471-0528.16729
DO - 10.1111/1471-0528.16729
M3 - Review article
C2 - 35411672
SN - 1470-0328
VL - 131
SP - 37
EP - 48
JO - BJOG - An International Journal of Obstetrics and Gynaecology
JF - BJOG - An International Journal of Obstetrics and Gynaecology
IS - S2
ER -