The Recognition of Excessive blood loss At ChildbirTh (REACT) Study: a two-phase exploratory, sequential mixed...

Area of Science:

• Obstetrics and Gynecology
• Clinical Decision-Making
• Patient Safety

Background:

• Postpartum hemorrhage (PPH) is a leading cause of maternal mortality worldwide.
• Accurate and timely recognition of excessive blood loss is critical for effective PPH management.
• Current diagnostic methods for PPH may not fully capture the nuances of clinical judgment.

Purpose of the Study:

• To explore how childbirth-related blood loss is evaluated and excessive bleeding recognized.
• To develop and test a theory of postpartum hemorrhage diagnosis.
• To understand the role of intuition and volume in PPH recognition.

Main Methods:

• Sequential mixed methods design involving qualitative (focus groups, interviews) and quantitative (simulations) phases.
• Involved women, birth partners, midwives, and obstetricians in two hospitals.
• Utilized high-fidelity childbirth simulators for quantitative assessment of PPH diagnosis.

Main Results:

• Recognition of excessive blood loss is primarily driven by automatic, intuitive reactions to the speed, nature, and visibility of blood flow.
• Health professionals found quantifying blood volume most useful for validating intuitive decisions post-PPH diagnosis.
• Treatment for PPH was initiated at or below 200 ml, with a tendency to treat fast, visible blood loss more readily than slow, less apparent loss.

Conclusions:

• Clinical decision-making in PPH is largely intuitive, with treatment initiated upon recognition of excessive loss.
• Women and birth partners desire increased information and open communication regarding blood loss during childbirth.
• Further research is needed to explore and support clinical decision-making processes in PPH management.