Strategies for optimising early detection and obstetric first response management of postpartum haemorrhage at caesarean birth: a modified Delphi-based international expert consensus
Creators: name: Oladapo, Olufemi T
name: Homer, Caroline
name: Hoang, Diem-Tuyet Thi
name: Lewis, Ayodele G
name: Widmer, Mariana
name: Main, Elliott K
name: Escobar, Maria Fernanda
name: Nunes, Inês
name: Downe, Soo
name: Miller, Suellen
name: Coomarasamy, Arri
name: Varallo, John
name: Carvalho, Brendan
name: Nabhan, Ashraf Fawzy
name: Arulkumaran, Sabaratnam
name: Pingray, Verónica
name: Hofmeyr, G Justus
name: Sosa, Claudio
name: Qureshi, Zahida P
name: Lumbiganon, Pisake
name: Evans, Cherrie
name: Dumont, Alexandre
name: Al-beity, Fadhlun M Alwy
name: Muriithi, Francis G
name: Galadanci, Hadiza S
name: Deneux-Tharaux, Catherine
name: Gallos, Ioannis
name: Williams, Caitlin R
name: Liabsuetrakul, Tippawan
name: Maua, Judith
name: Fawcus, Sue
name: Ortega, Vanesa
name: Blumenfeld, Alejandro
name: Abalos, Edgardo
name: Althabe, Fernando
name: Weeks, Andrew D
name: Phan, Thuan N Q
Publisher: name: BMJ
Year: 2024

description: <p>OBJECTIVE: There 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. DESIGN: Systematic review and three-stage modified Delphi expert consensus. SETTING: International. POPULATION: Panel of 22 global experts in PPH with diverse backgrounds, and gender, professional and geographic balance. OUTCOME MEASURES: Agreement or disagreement on strategies for early detection and first response management of PPH at caesarean birth. RESULTS: Experts 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. CONCLUSION: These 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.</p>