Patient priorities in postpartum hemorrhage management emphasize minimizing morbidity, revealing communication gaps despite high satisfaction

Severe postpartum hemorrhage (PPH) remains a leading cause of maternal morbidity and mortality worldwide, often requiring interventions beyond first-line oxytocin. While clinical guidelines focus on efficacy and safety of various treatments, patient perspectives on these interventions are often overlooked. Understanding patient experiences and priorities is crucial for developing truly patient-centered care strategies and improving shared decision-making. This study addresses the gap in knowledge regarding patient satisfaction and communication surrounding second-line PPH management options.

Researchers conducted a cross-sectional survey from January to April 2024 involving 100 postpartum individuals (age 18-50, gestational age ≥37 weeks) who experienced abnormal bleeding requiring treatment beyond oxytocin at a tertiary academic center. The study assessed patient priorities, their experiences with various treatments, and satisfaction with the decision-making process. Participants were categorized by the type of intervention received, including uterotonics alone, antifibrinolytics, intrauterine vacuum device, or surgical intervention, to compare outcomes and satisfaction levels.

Among the 100 consented participants, 92% received uterotonics, 26% received antifibrinolytics, 9% underwent an intrauterine vacuum device procedure, and 1% required surgical intervention. Patient priorities, which included minimizing blood loss, avoiding transfusion, and optimizing recovery, were consistently valued across all treatment groups. However, significant differences were observed between treatment types regarding clinical outcomes and patient satisfaction. Device users experienced substantially higher estimated blood loss (1755 mL vs. 516 mL, p<0.001) compared to those treated with uterotonics alone. They also required more blood transfusions (33.3% vs. 5.9%, p=0.01) and had a higher rate of subsequent surgical interventions (11.1% vs. 0%, p<0.01). Notably, dissatisfaction with treatment (5.4%) and clinician communication (15.1%) occurred exclusively among patients who received uterotonics, despite overall high satisfaction rates.

Patient priorities (minimizing blood loss, avoiding transfusion, optimizing recovery) were consistent across all groups, highlighting shared patient values regardless of treatment complexity.