Systematic Review Synthesizes 23 Best Practices for Postpartum Hemorrhage Prevention and Management

Postpartum hemorrhage (PPH) remains a leading cause of maternal mortality worldwide, despite existing guidelines from organizations like the World Health Organization. A significant gap persists in the consistent implementation of these recommendations, particularly in low-resource settings, contributing to persistently high PPH-related mortality. This highlights a critical need for accessible, synthesized evidence to guide clinical practice effectively. Understanding and applying the most current, evidence-based strategies for both preventing and managing PPH is crucial for improving maternal health outcomes.

Researchers conducted a systematic review using the PIPOST framework to define the evidence-based question across six dimensions: Population, Intervention, Professionals, Outcome, Setting, and Type of evidence. A top-down systematic search followed the 6S pyramid evidence model, encompassing international and domestic resources, including guideline repositories and major databases. Diverse evidence types, such as clinical decisions, guidelines, systematic reviews, expert consensuses, and nursing studies, were included. The quality of eligible literature was rigorously appraised, and guidelines were evaluated using the AGREE II instrument to ensure reliability. Key information related to PPH prevention was extracted and graded. Ultimately, 13 publications were included: 2 guidelines, 2 expert consensuses, 1 evidence summary, 3 nursing/survey studies, 1 systematic review, and 3 review articles.

This systematic review synthesized 23 best practice recommendations for postpartum hemorrhage prevention and management, categorized across 11 distinct domains. These domains include crucial areas such as risk assessment, anemia management, health education, mode of delivery selection, and oxytocin administration. Other key areas covered are active management of the third stage of labor, labor control, vital signs monitoring, and vaginal assessment. The recommendations aim to provide clear, evidence-based guidance for healthcare professionals. The comprehensive synthesis of 13 diverse publications, ranging from guidelines to systematic reviews, underscores the multifaceted approach required for effective PPH prevention and management. The rigorous quality appraisal using AGREE II ensures the reliability and validity of the synthesized recommendations. This structured approach helps bridge the gap between existing evidence and clinical application, particularly in settings where implementation challenges persist. The findings emphasize a holistic strategy, from pre-delivery preparation to immediate post-delivery care, to mitigate PPH risks.