REFERAT

Update on Evaluation, Prevention, and Management of Postpartum

Hemorrhage

Disusun Oleh:

Nobby Onist Junior Marbun

1261050029

Pembimbing :

dr. Christofel Panggabean, SpOG (K) FM

KEPANITERAAN KLINIK BAGIAN ILMU OBSGYN

PERIODE 07 MEI 2018 – 21 JULI 2018

FAKULTAS KEDOKTERANUNIVERSITAS KRISTEN INDONESIA

RSUD dr. Chasbullah Abdulmajid - BEKASI

2018
Update on Evaluation, Prevention, and Management
of Postpartum Hemorrhage
Kathleen Rice Simpson, PhD, RNC, CNS-BC, FAAN
n October 2017, the American

I College of Obstetricians and

Gynecologists (ACOG) updated
their recommendations on evalua-
tion, prevention, and management
of postpartum hemorrhage (PPH).
Risk factors are discussed in detail
and include the most common,
uterine atony, along with retained
placenta, lacerations of the birth
canal, uterine rupture, placenta
accreta, various types of coagulopa-
thies, uterine inversion, and infec-
tion. Use of a risk assessment tool
for PPH such as one discussed in the
toolkit for PPH published by the
California Maternal Quality Care
Collaborative (Lyndon, Lagrew,
Shields, Main, & Cape, 2015) is
recommended. Women can be
identified on admission as low,
medium, or high risk based on clin-
ical factors. These factors can
change over the course of labor
Postpartum hemorrhage guidelines have been
updated by ACOG based on evolving evidence on
evaluation, prevention, and management.
Key Recommendations for Postpartum Hemorrhage
(ACOG, 2017)
• Standard PPH response system (e.g., recommended by the Council on Patient Safety in
Women’s Healthcare [2015] that includes a functioning massive transfusion protocol with
fixed ratios of packed red blood cells, fresh frozen plasma, and platelets)
• Multidisciplinary response team
• Uterotonics as first-line treatment for PPH
• Timely escalation of treatment plan if uterotonics are not successful, including tamponade
techniques or surgical management
• Consideration for use of tranexamic acid if first-line treatments are unsuccessful
• Plans for maintaining hemodynamic stability
• Plans for identifying the PPH cause
• PPH drills
know what to expect and how to bers of the multidisciplinary team
respond when PPH occurs and as may help to encourage adoption to
the clinical situation evolves. The promote patient safety. ✜
PPH response system from the
Council on Patient Safety in Wom- Kathleen Rice Simpson is a Perinatal
en’s Healthcare (2015) that includes Clinical Nurse Specialist in St. Lou-
content based on the concepts of is, MO, and the Editor-in-Chief of
MCN. Dr. Simpson can be reached
via e-mail at krsimpson@prodigy.net
The author declares no conflicts
of interest.
Copyright © 2018 Wolters Kluwer
Health, Inc. All rights reserved.

and birth. Prevention is focused on readiness, recognition and preven- DOI:10.1097/NMC.0000000000000406

active management of the third
stage of labor including intrave-
nous or intramuscular oxytocin,
uterine massage, and umbilical
cord traction (ACOG).
A number of management strate-
gies are discussed including various
medications to treat uterine atony,
transfusion of blood products, tam-
ponade techniques, uterine artery
embolization, and surgical manage-
ment (ACOG, 2017). A major rec-
ommendation is use of a standard,
step-by-step assessment and
response protocol in all perinatal
units. All care providers should
tion, multidisciplinary response,
and reporting and system learning
is recommended, as are hemorrhage
drills and team-based learning.
Additional resources for PPH are
offered by ACOG at https://www.
acog.org/Womens-Health/Postpartum-
Hemorrhage#Providers. Nurses and
other members of the obstetric clin-
ical team should be aware of the
updated recommendations. If peri-
natal nurses are working on a unit
that does not have a PPH protocol
or obstetric hemorrhage drills,
review and sharing of the ACOG
practice bulletin with other mem-
References
American College of Obstetricians and Gyne-
cologists. (2017). Postpartum hemorrhage
(Practice Bulletin No. 183). Obstetrics and
Gynecology, 130(4), e168-e186. doi:10.1097/
AOG.0000000000002351
Council on Patient Safety in Women’s Health-
care. (2015). Obstetric hemorrhage (Patient
Safety Bundle). Retrieved from http://safe
healthcareforeverywoman.org/patient-
safety-bundles/obstetric-hemorrhage/
Lyndon, A., Lagrew, D., Shields, L., Main, E.,
& Cape, V. (Eds.). (2015). Improving health
care response to obstetric hemorrhage
version 2.0. A California quality improve-
ment toolkit. Stanford, CA: California
Maternal Quality Care Collaborative and
Sacramento, California Department of
Public Health. Retrieved from https://www.
cmqcc.org/resources-tool-kits/toolkits/
ob-hemorrhage-toolkit

120 volume 43 | number 2 March/April 2018

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.