Bethany Carr

and 5 more

Background: Postpartum Haemorrhage (PPH) remains a leading cause of maternal mortality and morbidity worldwide, and the rate is increasing. Using a reliable predictive model could identify those at risk, support management and treatment, and improve maternal outcomes. Objectives: To systematically identify and appraise existing prognostic models for PPH and ascertain suitability for clinical use. Search strategy: MEDLINE, CINAHL, Embase, and the Cochrane Library were searched using combinations of terms and synonyms including ‘postpartum haemorrhage’, ‘prognostic model’, and ‘risk factors’ that were developed from a scoping review. Selection Criteria: Observational or experimental studies describing a prognostic model for risk of PPH, published in English. Data Collection and Analysis: The Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies checklist informed data extraction and Prediction Model Risk of Bias Assessment Tool guided analysis. Main Results: 16 studies met the inclusion criteria after screening 1612 records. All studies were hospital settings from 8 different countries. Models were developed for women who experienced vaginal birth (n=7), caesarean birth(n=2), any type of birth(n=2), hypertensive disorders(n=1) and those with placental abnormalities(n=4). All studies were at high risk of bias due to use of inappropriate analysis methods or omission of important statistical considerations or suboptimal validation. Conclusions: No existing prognostic models for PPH are ready for clinical application. Future research is needed to externally validate existing models and potentially develop a new model that is reliable and applicable to clinical practice. Funding: This study received no funding. Keywords: Postpartum haemorrhage, prognostic model, prediction tool.

Fitriana Ekawati

and 4 more

Objectives: To reach consensus on evidence-based recommendations to develop HDP management pathways for Indonesian primary care. Design: A three-round Delphi survey Setting: N/A Population: Maternal health practitioners and experts, including GPs, midwives, nurses and health policy researchers from Indonesia and international background. Methods: Participants were asked to rate their agreement on whether each of 125 statements about HDP and HDP managements extracted from international guidelines were feasible in Indonesian primary care settings in a mix of quantitative and qualitative questions in three-rounds Delphi survey. A minimum of 70% agreement among participants was needed for a statement to be included for the HDP pathways that the pathways drafts were presented at the third-round survey. The participants’ free text questions responses and suggestions were analysed thematically. Main Outcome Measures: Agreement scores of the statements. Results: A total of 52 participants participated, 48, 45, and 37 of them completed the first, second and third-round survey respectively. The consensus was reached for 115 of the 125 statements on HDP definition, screening, management and long-term follow-up. The agreement scores ranged from 70.8-100.0% and potential implementation barriers were also identified. Drafts of HDP management pathways were also agreed upon and received suggestions from the participants. Conclusions: Most evidence-based HDP management recommendations achieved consensus represented in the developed HDP management pathways can be implemented in Indonesian settings. Further investigations are needed to explore the acceptability and feasibility of the pathways in practice.