Evaluation of a multifaceted postpartum hemorrhage-management intervention in community hospitals in Southern Thailand

Abstract

Objective: To assess a multifaceted postpartum hemorrhage (PPH)-management intervention in community hospitals in Southern Thailand.

Methods: The present prospective study was conducted from November 1, 2012 to April 30, 2015. The medical records of women with PPH were collected before (January 1, 2011, and October 31, 2012) and after (March 1, 2013, and December 31, 2014) the implementation of a multifaceted PPH-management intervention at three community hospitals in Southern Thailand; these patients were compared with patients diagnosed with PPH at three control hospitals in the same provinces during the same time periods. The intervention, delivered to general practitioners and nurses, utilized previously developed PPH-management guidelines. PPH management was compared between the intervention and control hospitals and factors associated with PPH management were evaluated using univariate and multiple logistic regressions.

Results: The post-intervention median blood loss within 2 hours of delivery was lower in intervention hospitals (P<0.001) and post-intervention indwelling bladder catheterization was higher (P=0.004). Increased odds of indwelling bladder catheterization were recorded among patients treated at intervention hospitals (adjusted odds ratio [aOR] 2.79, 95% confidence interval [CI] 1.40-5.55) and patients who experienced more than 500 mL of blood loss (501-1000 mL [aOR 2.41, 95% CI 1.22-4.76] or >1000 mL [aOR 16.45, 95% CI 2.04-132.80]).

Conclusion: Implementation of the multifaceted intervention improved PPH management at community hospitals.

Keywords: Community hospital; Management; Multifaceted intervention; Postpartum hemorrhage.