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Evaluation of compliance and outcomes of a management protocol for massive postpartum hemorrhage at a tertiary care hospital in Pakistan.doc

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Evaluation of compliance and outcomes of a management protocol for massive postpartum hemorrhage at a tertiary care hospital in Pakistan

Sheikhetal.BMCPregnancyandChildbirth2011,11:28 /1471-2393/11/28 RESEARCH ARTICLE OpenAccess Evaluationofcomplianceandoutcomesofa managementprotocolformassivepostpartum hemorrhageatatertiarycarehospitalinPakistan LumaanSheikh1,NidaNajmi1,UmairKhalid2andTaimurSaleem2* Abstract Background:Massivepostpartumhemorrhageisalifethreateningobstetricemergency.Inordertopreventthe complicationsassociatedwiththiscondition,anorganizedandstep-wisemanagementprotocolshouldbe immediatelyinitiated. Methods:Anevidencebasedmanagementprotocolformassivepostpartumhemorrhagewasimplementedat AgaKhanUniversityHospital,Karachi,Pakistanafteranauditin2005.Wesoughttoevaluatethecomplianceand outcomesassociatedwiththismanagementprotocol3yearsafteritsimplementation.Areviewofalldeliveries withmassiveprimarypostpartumhemorrhage(bloodloss≥1500ml)betweenJanuary,2008toDecember,2008 wascarriedout.Informationregardingmortality,modeofdelivery,possiblecauseofpostpartumhemorrhageand medicalorsurgicalinterventionwascollected.Theestimationofbloodlosswasmadeviasubjectiveandobjective assessment. Results:During2008,massivepostpartumhemorrhageoccurredin0.64%cases(26/4,052).Nodeathswere reported.Themeanbloodlosswas2431±1817ml(range:1500-9000ml).Emergencycesareansectionwasthe mostcommonmodeofdelivery(13/26;50%)whileuterineatonywasthemostcommoncauseofmassive postpartumhemorrhage(14/26;54%).B-lynchsuture(24%)andballoontamponade(60%)wereusedmore commonlyascomparedtoourpreviouslyreportedexperience.Cesareanhysterectomywasperformedin3cases (12%)forcontrolofmassivepostpartumhemorrhage.Morethan80%compliancewasobservedin8outof 10stepsofthemanagementprotocol.Initiationofbloodtransfusionat1500mlbloodloss(89%)andoverall documentationofmanagement(92%)werefavorablyobservedinmostcases. Conclusion:Thisreportdetailsourexperiencewiththepracticalimplementationofamanagementprotocolfor massivepostpartumhemorrhageatatertiarycarehospitalinadevelopingcountry.Withtheexceptionofarterial embolization,relativelynewer,simplerandpotentiallysafe