Abstract
BackgroundPostpartum haemorrhage (PPH) is still one of the major causes of severe maternal morbidity and mortality worldwide. Currently, no guideline for PPH occurring in primary midwifery care in the Netherlands is available. A set of 25 quality indicators for prevention and management of PPH in primary care has been developed by an expert panel consisting of midwives, obstetricians, ambulance personal and representatives of the Royal Dutch College of Midwives (KNOV) and the Dutch Society of Obstetrics and Gynecology (NVOG). This study aims to assess the performance of these quality indicators as an assessment tool for midwifery care and suitability for incorporation in a professional midwifery guideline.MethodsFrom April 2008 to April 2010, midwives reported cases of PPH. Cases were assessed using the 25 earlier developed quality indicators. Quality criteria on applicability, feasibility, adherence to the indicator, and the indicator’s potential to monitor improvement were assessed.Results98 cases of PPH were reported during the study period, of which 94 were analysed. Eleven indicators were found to be applicable and feasible. Five of these indicators showed improvement potential: routine administration of uterotonics, quantifying blood loss by weighing, timely referral to secondary care in homebirth and treatment of PPH using catherisation, uterine massage and oxytocin and the use of oxygen.ConclusionsEleven out of 25 indicators were found to be suitable as an assessment tool for midwifery care of PPH and are therefore suitable for incorporation in a professional midwifery guideline. Larger studies are necessary to confirm these results.
Highlights
Postpartum haemorrhage (PPH) is still one of the major causes of severe maternal morbidity and mortality worldwide
No guideline for PPH occurring in primary midwifery care in the Netherlands is available
A set of 25 quality indicators for prevention and management of PPH in primary care has been developed by an expert panel consisting of midwives, obstetricians, ambulance personal and representatives of the Royal Dutch College of Midwives (KNOV) and the Dutch Society of Obstetrics and Gynecology (NVOG) [7]
Summary
Postpartum haemorrhage (PPH) is still one of the major causes of severe maternal morbidity and mortality worldwide. No guideline for PPH occurring in primary midwifery care in the Netherlands is available. Of all women who give birth in primary midwifery care, the incidence of PPH is 3.4% [13]. In a primary care setting, limited hands-on assistance and the necessity of arranging ambulance transfer (in case of home birth) make the availability of a specific guideline for midwifery care essential. This paper describes the performance of those quality indicators in clinical practice as an assessment tool for midwifery care and suitability for incorporation in a professional midwifery guideline. Validation is necessary to demonstrate the value of the set of indicators as an instrument for monitoring and improving prevention and management of PPH in primary care [17,18]
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