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Development of an assessment and intervention protocol for postpartum hemorrhage in the mainland of China: an evidence-based method and Delphi consult


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Items included for the second-round consult.

First levelSecond levelThree levelAgreement (%)Scoring of importance
MSDCV
I-1 Prevention StrategiesII-2 AMTSLLate cord clamping50.004.071.210.30
CCT42.864.001.110.28
I-2 Assessment StrategiesII-3 ABC AssessmentAirway assessment50.004.210.890.21
Breathing assessment50.004.290.830.19
II-4 Blood loss assessmentAssessing blood amount: calculate the percentage of blood loss when over 500 mL42.864.001.110.28
I-3 Intervention StrategiesII-7 Mild PPH (blood loss 500–1000 mL)Fluid management: choose #16 or larger needles92.864.930.270.06
Airway management: assess the breath sound and apply oxygen therapy for 6–10 L/min64.294.570.650.14
Continuous assessment: electrocardiogram monitor is applied85.714.860.360.07
Uterine atony: uterine massage64.294.500.760.17
Birth canal injury: check for hematoma, cut it for drainage, suture or compress for hemostasis71.434.710.470.10
Observe for signs of placenta abruption, and palpate the uterus fundus to assess contraction42.864.071.140.28
CCT is performed for vaginal births once the placenta has been retaining for 30 min64.294.500.760.17
Apply ultrasonography if available50.004.360.750.17
II-8 Moderate PPH (blood loss 1000–2000 mL)Airway management: assess the breath sound and apply oxygen therapy for 10–15 L/min71.434.640.630.14
Establish the second venous access92.864.930.270.06
Adjust the infusion rate to the maximum and apply pressure to the fluid bag if necessary85.714.860.360.07
Body position management: change into supine or Trendelenburg’s position64.294.640.500.11
Temperature management: use warm fluid or heating device, and keep fluid temperature around 40℃64.294.640.500.11
Vital signs assessment: assess temperature every 15 min42.863.861.350.35
Urine assessment: every 15 min after catheterization85.714.640.930.20
Uterine atony: apply hemostatic drugs if uterotonics fails or trauma exists42.864.140.770.19
Uterine atony: abdominal aortic compression42.864.290.730.17
II-10 Nursing care after rescueHemodynamic changes: observe for 2 hours in the delivery room before transferring92.864.930.270.06
Hemodynamic changes: observe for vital signs, uterine contraction and loss of blood every 4 hours in the ward for the first 24 hours92.864.930.270.06
I-5 Health Education after PPHII-13 Health education for puerpera and familyPrevention of complications: anemia64.294.640.500.11
Prevention of complications: Sheehan syndrome50.004.430.650.15
Breast feeding instructions64.294.570.650.14
Psychological instructions64.294.500.760.17

Basis of judgment and quantification of influence levels.

Basis of judgmentInfluence level
HighModerateLow
Theoretical analysis0.30.20.1
Empirical evidence0.50.40.3
Peer communication0.10.10.1
Intuition0.10.10.1
Total1.00.80.6

Self-evaluation of the basis of judgment.

Basis of judgmentInfluence level
HighModerateLow
Theoretical analysis1310
Empirical evidence1310
Peer communication761
Intuition437

Demographic characters of the expert panel (n = 14).

DemographicsNumber of expertsPercentage (%)
Gender
Male17.14
Female1392.86
Age (years)
30–39642.86
40–49321.43
≥50535.71
Title
Lecturer*750.00
Associate professor*321.43
Professor*428.57
Academic degree
Bachelor964.29
Master428.57
PhD17.14
Profession
Medicine428.57
Nursing1071.43
Working experience (years)
10–19642.86
20–29428.57
≥30428.57
eISSN:
2544-8994
Language:
English
Publication timeframe:
4 times per year
Journal Subjects:
Medicine, Assistive Professions, Nursing