Tuesday, June 18, 2024

Consensus Achieved on Postpartum Hemorrhage Management for Cesarean Births

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In an effort to standardize the first response to postpartum hemorrhage (PPH) during cesarean deliveries, a new study has successfully established an international expert consensus on the subject. This landmark research, which examines both intraoperative and postoperative phases, suggests strategies to enhance early detection and initial management of PPH, aiming to optimize outcomes for mothers worldwide.

Study Design and Expert Involvement

The research was structured around a systematic review combined with a three-stage modified Delphi process, involving a diverse panel of 22 global experts in PPH. These experts, representing a balance in gender, profession, and geography, deliberated on various strategies to detect and manage PPH effectively during and after cesarean sections.

Key Findings and Agreements

The consensus confirmed that the definition of PPH should be uniform across both vaginal and cesarean births. During the surgery, it was agreed that early detection of PPH should involve quantitative measurement of blood loss and monitoring of hemodynamic status. The trigger for the first response is set at a blood loss of at least 500 mL with ongoing bleeding, or the onset of signs indicating hemodynamic instability, whichever comes first. Initial responses include prompt administration of uterotonics and tranexamic acid, coupled with rapid identification of the bleeding source and tailored interventions.

In the postoperative stage, frequent monitoring of hemodynamic status and clinical signs of internal bleeding are essential for timely detection of PPH, supported by quantitative or visually estimated assessments of cumulative blood loss. The initial postoperative response necessitates a customized approach based on the individual’s condition.

Practical Inferences from the Study

  • Uniform PPH definitions enhance clarity and consistency in both vaginal and cesarean deliveries.
  • Quantitative blood loss measurement is crucial for accurate PPH detection during cesarean sections.
  • Rapid administration of uterotonics and tranexamic acid is vital in the first response to PPH.
  • Customized postoperative strategies are essential for effective PPH management.

The findings from this study provide a structured framework that hospitals and healthcare providers can adopt to improve the management and outcomes of PPH during cesarean births. The consensus on these strategies marks a significant step forward in the standardized care of women undergoing cesarean sections, potentially leading to better health outcomes.

Original Article: BMJ Open. 2024 May 8;14(5):e079713. doi: 10.1136/bmjopen-2023-079713.

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