Strategies for optimising early detection and obstetric first response management of postpartum haemorrhage at caesarean birth: a modified Delphi-based international expert consensus.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Pingray Verónica, Williams Caitlin R, Al-Beity Fadhlun M Alwy, Abalos Edgardo, Arulkumaran Sabaratnam, Blumenfeld Alejandro, Carvalho Brendan, Deneux-Tharaux Catherine, Downe Soo, Dumont Alexandre, Escobar Maria Fernanda, Evans Cherrie, Fawcus Sue, Galadanci Hadiza S, Hoang Diem-Tuyet Thi, Hofmeyr G Justus, Homer Caroline, Lewis Ayodele G, Liabsuetrakul Tippawan, Lumbiganon Pisake, Main Elliott K, Maua Judith, Muriithi Francis G, Nabhan Ashraf Fawzy, Nunes Inês, Ortega Vanesa, Phan Thuan N Q, Qureshi Zahida P, Sosa Claudio, Varallo John, Weeks Andrew D, Widmer Mariana, Oladapo Olufemi T, Gallos Ioannis, Coomarasamy Arri, Miller Suellen, Althabe Fernando
Аннотация
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.