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Published on: April 7, 2023
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Clinical algorithms for management of third stage abnormalities.
J K Marcus1, S Fawcus1,
1Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
Summary
Algorithms were developed to manage postpartum haemorrhage (PPH) and other third stage of labour abnormalities. These standardized approaches are crucial for improving maternal care, especially in low-resource settings.
Area of Science:
- Obstetrics and Gynecology
- Maternal Health
- Clinical Algorithm Development
Background:
- Postpartum haemorrhage (PPH) remains a leading cause of maternal mortality worldwide.
- Standardized management protocols are essential for effective PPH care, particularly in resource-limited settings.
- Existing guidelines may not fully address the complexities of PPH and related third-stage labour abnormalities.
Purpose of the Study:
- To develop evidence-based algorithms for the identification, management, and monitoring of PPH.
- To create standardized approaches for other third-stage of labour abnormalities, including uterine atony, genital tract trauma, and retained placenta.
- To provide tools for improving maternal outcomes in vaginal deliveries, with a focus on low- and middle-income countries (LMICs).
Main Methods:
- Systematic literature searches were conducted for international/national guidance, research databases (Cochrane, Medline, CINAHL), and systematic reviews.
- Searches were limited to English-language publications from January 1, 2008, to December 31, 2018.
- Four interlinked case scenarios were defined for algorithm development: PPH, uterine atony, genital tract trauma, and retained placenta.
Main Results:
- Algorithms were developed for the assessment, resuscitation, treatment, and monitoring of four key case scenarios related to PPH and third-stage labour abnormalities.
- The algorithms provide a clear, evidence-based framework for clinical decision-making.
- The developed algorithms are intended for field testing and potential adaptation into electronic decision support tools.
Conclusions:
- The developed algorithms offer standardized approaches for managing PPH and related complications after vaginal delivery.
- Further research is recommended on multimodal care packages, conservative surgical measures, resuscitation in LMICs, and integrating respectful maternity care.
- Field testing and evaluation are necessary to confirm the effectiveness of these algorithms in diverse healthcare settings.
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