Third-trimester polyunsaturated fatty acid supplementation and increased blood loss at vaginal delivery: A prospective birth cohort study.

This study aims to investigate the threshold effect of labor duration on adverse outcomes associated with cesarean sections in pregnant women with gestational hypertension and preeclampsia (GH-PE). This study conducted a retrospective cohort study on 1188 pregnant women who delivered at our hospital from January 1, 2022, to December 31, 2024. The effect of the threshold value of the labor duration for successful vaginal delivery among pregnant women with GH-PE was analyzed through curve fitting. And compare the adverse outcomes of emergency cesarean section before and after the threshold of labor duration. Among the 1188 samples, all were primiparous women who underwent cervical balloon dilation for the induction of labor. In pregnant women with GH-PE, an analysis of the threshold effect of cervical dilation duration from 2 to 4 cm on successful vaginal delivery shows that the shorter the time taken for cervical dilation, the higher the success rate of vaginal delivery. However, once this time exceeds 3.1 hour, the success rate of vaginal delivery basically remains stable. Meanwhile, it was also found that in pregnant women with GH-PE who underwent emergency cesarean section during delivery, when the duration for cervical dilation from 2 to 4 cm exceeded 3.1 hour, the incidence of postpartum hemorrhage (odds ratio: 5.97, 95% confidence interval: 1.38–25.78) and the volume of postpartum hemorrhage were higher compared to those with a duration of ≤ 3.1 hour. For primiparous women with GH-PE undergoing cervical balloon induction, the inflection point for successful vaginal delivery may be when the cervical dilation reaches 2 to 4 cm within 3.1 hour, and transfer to cesarean section before the inflection point might be possible to reduce the incidence of postpartum hemorrhage.

This study investigates the relationships among psychological state, sleep patterns, COVID-19 vaccination during the COVID-19 pandemic, with postpartum hemorrhage as the primary outcome, and other adverse pregnancy outcomes, mental health, and sleep quality as secondary outcomes. A prospective cohort study was conducted from April 2022 to November 2022 at the First Affiliated Hospital of Sun Yat-sen University, including 260 pregnant women meeting the inclusion criteria in the obstetric department. The Depression Anxiety Stress Scales (DASS-21) was used to assess depression, anxiety, and stress; the Impact of Event Scale-Revised (IES-R) was utilized to evaluate psychological stress related to COVID-19, and the Pittsburgh Sleep Quality Index (PSQI) was employed to measure sleep quality; Participants were grouped based on their scores or vaccination status (vaccinated: n = 204; unvaccinated: n = 56), and the incidence of adverse pregnancy outcomes was compared among different groups. The primary outcome showed that the incidence of postpartum hemorrhage (PPH) differed significantly across depression subgroups (normal: 3.6%, mild: 15.0%, moderate-severe: 13.0%; χ²(2) = 9.450). Compared with the non-depression group, mild depression was significantly associated with an increased risk of PPH (OR = 4.19, 95% CI: 1.15-15.18, P = 0.006); moderate-to-severe depression was also significantly associated with an elevated risk of PPH (OR = 4.78, 95% CI: 1.39-16.40, P = 0.013). For secondary outcomes, no significant differences in adverse pregnancy outcomes were observed among groups stratified by anxiety, stress, COVID-19-related psychological stress, or sleep quality (all P > 0.05).In addition, pre-pregnancy inactivated COVID-19 vaccination was not associated with an elevated risk of PPH or other adverse pregnancy outcomes(P > 0.05). COVID-19-related depressive symptoms are associated with an increased risk of postpartum hemorrhage. Pre-pregnancy COVID-19 vaccination showed no adverse effects on maternal mental health or pregnancy outcomes.

Conventional health education may not fully address the difficulty of translating GDM-related knowledge into sustained self-management behaviors. This study aimed to evaluate whether a PRECEDE-PROCEED Model-based GDM health education program was associated with improved self-management ability and pregnancy outcomes in patients with GDM. This single-center retrospective matched-cohort study was conducted at Huzhou Maternity & Child Health Care Hospital and included clinical data of pregnant women who underwent regular prenatal examinations in the obstetric outpatient department and were diagnosed with GDM from August 2024 to August 2025. Based on the nursing methods received, the participants were divided into an observation group (GDM health education intervention program based on the PRECEDE-PROCEED Model) and a control group (standard GDM health education intervention program). A total of 150 patients were enrolled. Patients were matched at a 1:1 ratio, with 75 cases in each group. Post-intervention, fasting and two-hour postprandial blood glucose levels were lower in the observation group than in the control group (p<0.05), and two-hour postprandial blood glucose decreased after intervention in both groups. Scores of GDM-related knowledge, management behaviors, attitudes, beliefs, and social support were significantly elevated in both groups, and considerably higher in the observation group (p<0.05). The incidence of postpartum hemorrhage and hypertensive disorders of pregnancy was notably lower in the observation group (p<0.05). Compared with conventional health education, the GDM health education intervention program based on the PRECEDE-PROCEED Model was associated with better blood glucose levels in GDM patients, improved self-management skills, and lower incidence rates of postpartum hemorrhage and hypertensive disorders of pregnancy.

ObjectiveTo investigate whether prophylactic tranexamic acid reduces the incidence of postpartum haemorrhage in women with placenta praevia compared with placebo.DesignRandomised, double blind, placebo controlled, phase 3 study.Setting24 maternity units across China between July 2023 and March 2025.Participants1732 women with placenta praevia undergoing caesarean delivery.InterventionsParticipants were randomly (1:1) assigned to receive prophylactic oxytocin and either tranexamic acid (1 g in 10 mL) or placebo (10 mL normal saline) diluted in 40 mL normal saline intravenously over 10 minutes, initiated within five minutes of umbilical cord clamping.Main outcome measuresThe primary outcome was postpartum haemorrhage, defined as calculated estimated blood loss ≥1000 mL or as red cell transfusion within two days after delivery. Serious adverse events included thromboembolic events, seizures, acute kidney or liver injury, and maternal death.ResultsOf 1732 women with placenta praevia who were randomised, 38 were excluded because they withdrew consent or were determined to be ineligible after randomisation. Primary outcome data were available for 99.8% (1691/1694) of the remaining women. Placenta accreta spectrum was diagnosed in 303 participants (17.9%). The primary outcome occurred in 29.7% (251/845) of the tranexamic acid group and 35.1% (297/846) of the placebo group (relative risk 0.85, 95.2% confidence interval (CI) 0.75 to 0.96; P=0.01). The rates of serious adverse events were similar between the tranexamic acid group and placebo group (0.5% (4 of 837) v 0.5% (4 of 845); relative risk 1.01, 95% CI 0.25 to 4.00).ConclusionsIn women with placenta praevia who underwent caesarean delivery and received prophylactic oxytocin, treatment with tranexamic acid resulted in a statistically significant yet modest reduction in the incidence of postpartum haemorrhage, with no signal of increased serious adverse events.Trial registrationClinicalTrials.gov NCT05811676.

Carbetocin vs oxytocin for prevention of postpartum hemorrhage in women with obesity undergoing cesarean delivery: A systematic review and meta-analysis.

Tranexamic acid use for the prevention of postpartum hemorrhage in high-income countries: a review of recent literature

The incidence of postpartum hemorrhage (PPH) has increased despite consistent use of prophylactic treatment. To date, little is known about postpartum uterine activity. This study investigates the association between various uterine activity parameters and blood loss in the first 30 min postpartum. Term pregnant patients who received postpartum continuous electrophysiological uterine monitoring were included. Postpartum blood loss was measured using weighting. From a 30-min electrohysterography-derived tocogram, a computer-based algorithm was used to extract uterine activity parameters. These included total area under the curve (AUC), AUC from baseline, maximum amplitude and baseline tone. Scatterplots between various UA parameters and logarithmically transformed total blood loss were made and Pearson correlation coefficients were calculated. UA-parameters were compared between non-PPH patients and patients with PPH, including the different PPH etiologies. 119 patients were included of which 24 had PPH (blood loss ≥500 mL). Total blood loss showed no significant association with the various UA-parameters. Patients with PPH due to a retained placenta (n = 6) showed significantly higher total UA-AUC (5.5 vs 5.2, p = 0.007), UA-AUC from baseline (5.4 vs 5.1, p = 0.003) and maximum amplitude (3.0 vs 2.9, p = 0.024) compared to patients without PPH. Increased postpartum uterine activity may reflect compensatory but ineffective myometrial activation in patients with PPH due to a retained placenta. Due to the limited sample size and exploratory nature of the analyses, these results should be interpreted with caution.

Severity of admission anemia and risk of postpartum hemorrhage: a single-center retrospective cohort study (2024-2025).

Based on the hypothesis that the effect of general anesthesia (GA) vs. neuraxial anesthesia (NA) on postpartum hemorrhage (PPH) varies according to its underlying etiology, this study aimed to investigate the impact of the anesthetic technique on the risk of severe PPH indistinct clinical scenarios: (1) emergency cesarean deliveries at risk for uterine atony and (2) cases of placenta accreta spectrum (PAS) at risk for massive surgical hemorrhage. In this retrospective dual-cohort study, patients receiving GA in Cohort 1 were matched 1:3 to NA patients using propensity score matching (PSM). Cohort 2 comprised patients with PAS who underwent scheduled cesarean hysterectomy. The primary endpoint was severe PPH, and the results were analyzed statistically. In the matched Cohort 1 (n = 600), the incidence of severe PPH was significantly higher in the GA group compared to the NA group (21.3 vs. 9.8%). After adjusting for operative duration and tranexamic acid use, GA was independently associated with an almost threefold increased risk of severe PPH [Adjusted Odds Ratio (aOR): 2.91; 95% Confidence Interval (CI): 1.80-4.69; p < 0.001]. In contrast, in Cohort 2 (n = 75), the rate of severe PPH was high in both groups, with no significant difference observed (91.1 vs. 86.7%; p > 0.05). However, post-hoc Bayesian analysis indicated a > 99 and 91% probability that GA is associated with increased blood loss in Cohort 1 and Cohort 2, respectively. In our matched cohort, general anesthesia was associated with an almost threefold increase in the risk of severe PPH in emergency cesarean deliveries susceptible to uterine atony. In cases such as the placenta accreta spectrum, the primary determinant of hemorrhage is the underlying surgical pathology, and the role of anesthetic management appears to be secondary. However, these findings for the PAS cohort should be considered exploratory due to the small sample size. In general, these results strongly support the personalization of anesthetic strategies based on the expected etiology of hemorrhage to reduce maternal morbidity and mortality.

Postpartum hemorrhage (PPH) is a primary cause of maternal mortality, accounting for 35% of maternal deaths globally. Active management of the third stage of labor (AMTSL) is a prophylactic intervention recommended by the World Health Organization for the prevention of PPH. Antifibrinolytic therapy with tranexamic acid (TXA) offers a potential strategy to minimize blood loss by inhibiting fibrin degradation. This study aims to compare the efficacy and safety of parenteral oxytocin with a low dose of TXA versus oxytocin administered within 2 min after vaginal delivery in the prevention of PPH. This randomized controlled study was conducted among 488 participants in a tertiary teaching center. Participants were randomly assigned to two groups to compare the effect of injection Oxytocin + injection TXA (1 g) versus injection Oxytocin after vaginal delivery in preventing postpartum hemorrhage. The incidence of PPH, reduction in hemoglobin and hematocrit values, proportion of women requiring supplementary uterotonics treatment, and incidence of postpartum transfusion were assessed. There were no notable differences between the two groups with regard to demographic data. The average expected blood loss is significantly lower among the test (Oxytocin + TXA) group, M = 321.1066, compared to the control (only Oxytocin) group, M = 503.0738, which depicted comparatively higher blood loss. P < 0.01 at 99% confidence interval. Hemoglobin level of the tested groups (M = 12.0545) was found to be comparatively higher than that of the control groups. The findings of our study indicate that the use of oxytocin with TXA is more effective in preventing PPH and minimizing blood loss compared to oxytocin alone.

ABSTRACTBackgroundGuidelines for managing a small symphysial fundal height (SFH) measurement during pregnancy are well established, but guidelines identifying and managing a large SFH measurement at term are not.AimsTo determine the relationship between a large SFH at term and intra‐partum risk, and to determine if there is an SFH cut‐off that could predict the following adverse outcomes: emergency caesarean section (CS), instrumental delivery, postpartum haemorrhage (PPH) and admission of neonate to the special care nursery (SCN).Materials and MethodsA retrospective audit was performed on 775 deliveries at a regional Australian hospital. SFH measurement at term was the primary variable for investigation. The largest measurement taken within 14 days of delivery was accepted as the primary SFH measurement.ResultsIn primiparous women, an SFH of 36 cm was associated with the lowest incidence of emergency CS (8%) and 35 cm was associated with the lowest incidence of PPH (8%). Both risks trebled at an SFH of 40 cm (24%) and quintupled at 43 cm (42%). In multiparous women the emergency CS rate was not correlated with SFH, but the PPH rate was correlated.ConclusionsA SFH measurement at term is currently a neglected but useful measurement for triaging women early in labour. An SFH of 36 cm is most reassuring as the parturient is at low risk of an emergency CS or a PPH whereas a SFH of 40 cm or more indicates increased risk and intra‐partum care should be modified to reflect this increased risk.

Postpartum hemorrhage (PPH) remains a major obstetric emergency and a leading cause of maternal morbidity and mortality. Uterotonics administered during the third stage of labor play a crucial role in its prevention. Carbetocin has emerged as a potential alternative to oxytocin due to its prolonged uterotonic effect and improved pharmacological profile. The study aimed to evaluate the effectiveness and safety of carbetocin in the prevention of PPH and to compare its outcomes with oxytocin using a combined intramuscular and intravenous oxytocin regimen in women undergoing vaginal or caesarean delivery. This prospective observational comparative study was conducted among 100 women (50 in each group) receiving either carbetocin (100 µg intramuscularly) or oxytocin (10 IU intramuscularly with additional intravenous infusion as per institutional protocol) immediately after delivery. Estimated blood loss, incidence of PPH (defined as ≥500 mL for vaginal delivery and ≥1000 mL for cesarean section), fall in hemoglobin, hemodynamic changes, and requirement for additional uterotonics were noted. Statistical analysis was performed, and a p-value <0.05 was considered significant. Baseline characteristics were comparable between groups. Mean estimated blood loss was significantly lower in the carbetocin group (410 ± 85 mL) compared to the oxytocin group (520 ± 110 mL; p<0.001). PPH occurred in three (6%) women in the carbetocin group versus 12 (24%) women in the oxytocin group (p=0.01). The mean fall in hemoglobin was lower with carbetocin (0.6 ± 0.4 g/dL vs 1.1 ± 0.6 g/dL; p<0.001). Additional uterotonics were required in two (4%) women receiving carbetocin compared to 11 (22%) women receiving oxytocin (p=0.007). Carbetocin was associated with better hemodynamic stability. Carbetocin was associated with reduced blood loss, lower PPH incidence, and improved hemodynamic stability compared to oxytocin within the context of differing prophylactic regimens. However, larger randomized studies are required to confirm these findings.

Background:Postpartum hemorrhage (PPH) stands out as a primary preventable cause of maternal mortality and morbidity. Therefore, the management and monitoring of PPH are of critical importance during the perinatal period. To evaluate the effectiveness of breastfeeding, uterine massage, and perineal protective approaches for preventing PPH during the perinatal period.Methods:This comparative controlled clinical study included 70 women in a tertiary care maternity hospital in Ankara, Turkey. Women were randomized according to age, parity, and optimality index-TR (OI-TR). Data were collected using sociodemographic and obstetric data collection forms, the LATCH Breastfeeding Assessment Tool, visual analog scale, and OI-TR. In addition to PPH awareness training, perineal protective techniques (perineal massage and open-glottis pushing technique), uterine massage, and breastfeeding support were provided to the intervention group (IG). Pregnant women in the control group (CG) underwent routine hospital procedures and care. Postpartum blood loss was measured in all groups.Results:The mean blood loss in women in the IG was significantly lower than that in the CG (r = 0.424, P < .05). However, no statistically significant difference was observed between the incidence of PPH (IG = 9.1%; CG = 27%) exceeding 500 mL in either groups (P > .05). Perineal laceration, delayed initiation of breastfeeding, a short breastfeeding duration, and a low OI-TR score were associated with high blood loss in the IG (r = 0.528, r = 0.392, r = 0.387, r = 0.457, P < .05). In the regression analysis performed by taking the variables found to be significant in univariate analyses, it was determined that the group effect was significant when the effects of other variables on PPH were ignored (β = 110.384, P < .01). However, when other variables were kept constant, the group effect was insignificant (β = 37.643, P = .607).Conclusions:Optimal care provided by midwives and nurses to support breastfeeding and implement perineal protective techniques reduces the risk of postpartum hemorrhage.

ObjectiveThe rate of failed trial of vaginal delivery (TVD) requiring subsequent cesarean section (CS) is relatively high among elderly multiparous women, which seriously impacts maternal and neonatal health. This study aimed to systematically investigate the factors influencing such conversion to CS in this population and evaluate their effects on maternal and neonatal outcomes, thereby providing evidence for clinical interventions.MethodsA retrospective analysis was conducted on all multiparous women aged over 35 years who had a history of vaginal delivery only, admitted to the First Affiliated Hospital of Jinan University from January 2022 to December 2023. After screening, the eligible subjects were divided into the vaginal delivery group and the converted cesarean section group. Univariate analysis was used to screen for potential influencing factors, followed by multivariate Logistic regression model to identify independent risk factors for conversion to CS. Meanwhile, differences in maternal and neonatal outcomes between the vaginal delivery group and the converted CS group were compared and analyzed.ResultsAmong the 510 elderly multiparous women, 422 achieved successful vaginal delivery, while 88 underwent conversion to CS due to failed TVD. Univariate analysis showed that maternal age and gestational weight gain (GWG) in the converted CS group were significantly higher than those in the vaginal delivery group (P < 0.05); there were statistically significant differences between the two groups in the incidence of gestational hypertension, hypothyroidism, and placenta previa (P < 0.05). Multivariate Logistic regression analysis revealed that age [OR = 1.113,P = 0.021,95%confidence interval (CI): 1.016–1.218], GWG above Institute of Medicine (IOM) guideline (OR = 1.977,P = 0.044,95%CI 1.019–3.837), gestational hypertension (OR = 6.903,P = 0.000,95%CI 3.127–15.239), Premature rupture of membranes (PROM)(OR = 0.263,P = 0.003,95%CI 0.108–0.644), hypothyroidism (OR = .044,P = 0.004,95%CI 1.434–6.464), and placenta previa (OR = 8.097,P = 0.006,95%CI 1.800–36.415) were all independent risk factors for conversion to CS (P < 0.05). The area under the receiver operating characteristic (ROC) curve of the binary Logistic regression model was 0.764 (95% CI: 0.709–0.820), indicating good predictive performance. In addition, the incidences of postpartum hemorrhage, neonatal asphyxia, fetal distress, and neonatal admission to the neonatal intensive care unit (NICU) in the converted CS group were significantly higher than those in the vaginal delivery group (P < 0.05).ConclusionConversion to CS due to failed TVD in elderly multiparous women is influenced by multiple factors, including maternal age, excessive GWG, and various pregnancy complications. In clinical practice, optimizing intrapartum management strategies, strengthening prenatal weight management, and enhancing fetal weight monitoring are expected to reduce the rate of conversion to CS and improve maternal and neonatal clinical outcomes.

Labor pain is a major physiological and psychological stressor for women during childbirth. Epidural analgesia is widely recognized as the most effective form of pain relief in labor, yet its utilization varies greatly, and uncertainty remains regarding its determinants and potential impact on maternal and neonatal outcomes. This study aimed to identify factors influencing the use of epidural analgesia and to evaluate its associations with labor progression and postpartum hemorrhage. This retrospective cohort included 1035 women who delivered at our hospital between 2020 and 2023. Univariable and multivariable logistic regression analyses were performed to identify independent determinants of epidural analgesia use. A clinical prediction model was developed and compared with eleven machine learning classifiers using receiver operating characteristic analysis. Associations between epidural analgesia and maternal-neonatal outcomes, particularly postpartum hemorrhage, were evaluated. Younger maternal age, primiparity, and lower pre-delivery fibrinogen levels were independently associated with the use of epidural analgesia. The logistic regression model demonstrated good discrimination (AUC = 0.70, 95% CI: 0.66-0.75), comparable to that of the machine learning models. Among vaginal deliveries, epidural analgesia was associated with longer total, first-stage, and second-stage labor durations (P < 0.001) but did not increase the incidence of postpartum hemorrhage or adverse maternal-neonatal outcomes. Across the entire cohort, higher pre-delivery D-dimer (OR = 1.54, 95% CI: 1.08-2.20, P = 0.017) and fibrinogen (OR = 1.34, 95% CI: 1.07-1.67, P = 0.010) levels were independent risk factors for postpartum hemorrhage, whereas epidural analgesia itself was not. Maternal age, parity, and coagulation status are key factors influencing the choice of epidural analgesia. Although epidural analgesia prolongs labor, it does not increase postpartum hemorrhage or other adverse outcomes. These findings support the safety of epidural analgesia and highlight the importance of assessing coagulation function to improve individualized labor management and prevent postpartum complications.

Postpartum hemorrhage (PPH) is a leading global cause of maternal mortality and morbidity. This study utilizes global burden of disease (GBD) data to assess its long-term trends in incidence, mortality, and disability-adjusted life years (DALYs). Using data from the GBD, we analyzed age-standardized incidence, mortality, and DALY rates among reproductive-aged women (15-49 years). Trend analysis was conducted via Joinpoint regression to estimate annual percentage changes (APCs), while future burden projections were modeled using Bayesian age-period-cohort (BAPC) analysis. From 1990 to 2021, the global age-standardized incidence rate (ASIR) of PPH declined significantly from 998.26 (95% UI: 654.55-1,438.33) to 722.16 (95% UI: 482.99-1,022.71) per 100,000 population. The estimated annual percentage change (EAPC) was -0.83% (95% UI: -0.90% to -0.77%). Projections suggest this downward trend will continue, with ASIR expected to reach 321.17 (95% UI: 302.55-359.30) by 2035. In 2021, women aged 20-24 years continued to exhibit the highest DALYs, amounting to 749,063 years (95% UI, 629,108.37-894,035.97). From 1990 to 2021, the proportion of DALYs among women of reproductive age attributable to iron deficiency-related PPH increased from 17.19% (95% UI, 8.65% to 21.48%) to 17.96% (95% UI, 8.67% to 23.95%). A sustained decline in the incidence of PPH over the past thirty years-a trend projected to continue through 2035, reflecting the ongoing effectiveness of public health interventions. We also found a potential association with iron deficiency, alongside a consistently higher disease burden observed among women aged 20-24 years.

ObjectiveAntenatal care (ANC) plays a critical role in improving maternal and neonatal health outcomes. However, incomplete ANC attendance in Somaliland is associated with adverse maternal and birth outcomes. Barriers to ANC attendance may increase the risk of pregnancy-related complications, including maternal morbidity, mortality and poor neonatal health outcomes. Understanding the effect of ANC attendance on maternal and birth outcomes is crucial for informing policies and interventions aimed at reducing these risks. Hence, this study aimed to assess the effect of ANC attendance on maternal and birth outcomes in Somaliland.DesignA prospective cohort study was conducted among 1205 pregnant women enrolled by systematic sampling method.Setting and participantsThe study was conducted in the Republic of Somaliland, which is situated in the Horn of Africa. Baseline data were collected at recruitment, and participants were followed up to delivery for the collection of outcome variables. The number of ANCs was considered to be a dichotomous independent variable; incomplete attendance (≤ 3 visits) and complete attendance (≥4 visits). The risk of pregnancy outcome among those with incomplete ANC was assessed using multi-variable logistic regression.VariablesThe outcome variables of the study were the maternal and birth outcomes. The independent variables included socio-demographic characteristics, such as age, residence, educational status, occupation, family size, wealth index and marital status, and reproductive factors, such as parity, gestational age at first ANC visit, current pregnancy desirability and previous pregnancy history.ResultsOut of the total participants, 43.3% of women had complete attendance. The incidence of postpartum haemorrhage was 10.0% (95% CI 8.6 to 12.3); antepartum haemorrhage, 3.6% (95% CI 2.6 to 4.7); caesarean section, 14.8% (95% CI 12.9 to 16.8); preterm delivery, 13.7% (95% CI 11.7 to 15.4); low birth weight, 25.8% (95% CI 23.4 to 28.1); and stillbirth, 3.2% (95% CI 2.3 to 4.2). Complete attendance to ANC significantly reduced the risk of antepartum haemorrhage, caesarean section, preterm delivery and admission to the neonatal intensive care unit and stillbirth.ConclusionNearly more than half of women in Somaliland had less than four ANC visits. The incidence of maternal and birth complications is higher among pregnant women who attended <4 ANC visits than among those who attended ≥4 ANC visits. Promoting access and quality ANC services would help in reducing maternal and neonatal complications in the country.

Pregnant hemophilia carriers receive prophylactic factor [F]VIII or FIX concentrate based on third trimester FVIII/FIX activity to reduce the risk of severe postpartum hemorrhage (PPH, ≥ 1000 mL). Due to persistently high severe PPH rates, Dutch guidelines were revised in 2018. Consensus was reached to increase the third trimester threshold for prophylaxis from < 50 to < 80 IU/dL and peak target levels during childbirth from ≥ 100 to ≥ 150 IU/dL. To assess the severe PPH incidence after guideline revision. Pregnant hemophilia carriers were prospectively enrolled (2018-2024) in Dutch hemophilia treatment centers to assess the severe PPH incidence after implementation of the revised guideline. FVIII/FIX activity and hematologic and obstetric outcomes were recorded and compared with a historical cohort (2012-2017). Statistics included descriptives and logistic regression to correct for confounders. Severe PPH occurred in 12.4% of 170 deliveries. No thrombosis was recorded. Prophylaxis in the subgroup with third trimester levels of < 80 IU/dL led to similar PPH rates to those with spontaneous rises of > 80 IU/dL. Compared with the historic cohort with the third trimester cutoff of < 50 IU/dL, the severe PPH incidence did not decrease (n = 170 vs n = 197; odds ratio, 1.16; 95% CI, 0.46-2.93), neither in the third trimester of the 50- to 80-IU/dL subgroup (n = 28/170 vs n = 21/197; odds ratio, 1.0; 95% CI, 0.20-2.90). Increasing the third trimester cutoff to < 80 IU/dL and aiming for ≥ 150 IU/dL at delivery did not decrease the risk for severe PPH in hemophilia carriers. More research is needed on optimal clotting factor levels during delivery to prevent severe PPH.

Postpartum hemorrhage (PPH) remains the leading cause of maternal mortality globally, including in Indonesia, where it accounts for 30.3% of maternal deaths. While PPH often occurs suddenly, its risk can be predicted at the time of hospital admission through systematic screening. However, the effectiveness of such screening depends on healthcare worker compliance, which can be hindered by administrative burdens. This study aims to evaluate the effectiveness of implementing a digital-based PPH admission screening tool in improving staff compliance and reducing PPH incidence at Muhammadiyah Gresik Hospital. Using an action research methodology under the Plan-Do-Study-Act (PDSA) framework, the study was conducted in two cycles. Cycle 1 employed a manual (paper-based) screening form, while Cycle 2 introduced a fully digital format. The study population included all maternity patients admitted during the intervention periods, with total sampling applied. Data were collected through direct observation, medical record audits, and hospital quality reports, and analyzed descriptively by comparing compliance and PPH rates across cycles. The findings indicate that the transition to a digital format significantly increased staff compliance from 89% in Cycle 1 to 100% in Cycle 2. Importantly, this improvement in compliance was directly associated with a reduction in PPH incidence from 3% at baseline to 1% post-digital intervention. The study concludes that digital-based admission screening serves as a crucial cognitive aid for strengthening risk management and advancing toward the zero-preventable-harm patient safety target.