Clinical algorithms for management of third stage abnormalities

Abstract

Aims To develop algorithms for identifying, managing and monitoring postpartum haemorrhage (PPH) and other third stage of labour abnormalities after vaginal delivery. Population Women with low-risk singleton term pregnancies who have had a vaginal delivery. Setting Hospital settings with a particular focus on healthcare facilities in low- and middle-income countries (LMICs). Search strategy Searches for international and national guidance documents, research databases (Cochrane, Medline and CINAHL) and published systematic reviews. Searches were limited to work published in English between 1 January 2008 and 31 December 2018. Case scenarios Four interlinked case scenarios were identified for algorithm development: (1) an approach to PPH after vaginal delivery, (2) uterine atony, (3) genital tract trauma and (4) retained placenta/placental products. Conclusions The development of clear approaches to the assessment, resuscitation, treatment and monitoring of the four case scenarios are presented as algorithms, based on available evidence. They need to be field tested and evaluated for effectiveness, and may be adapted for electronic decision support tools using artificial intelligence in different settings. Further research is needed around multimodal sequential packages of care for PPH, conservative surgical measures, resuscitation in LMICs, and how a respectful maternity care focus can be incorporated into the algorithms. Keywords Algorithms, emergency obstetric care, low- and middle-income countries, low-resource settings, management, postpartum haemorrhage, prevention, Sub-Saharan Africa. Tweetable abstract Algorithm development for standardised approaches to managing PPH in low-resource settings.