Althabe F, Therrien MNS, Pingray V, et al.
International Journal of Gynaecology & Obstetrics, 2019.
This technical consultation was conducted to systematically develop evidence-based bundles for care of PPH. Based on 12 criteria agreed upon by experts to assess PPH care bundles, their definition, median relevance rates, and the level of agreement in accordance with the RAND (RAND/UCLA Appropriateness Method) relevance ratings, two care bundles were defined including: 1) “First response to PPH bundle” comprises uterotonics, isotonic crystalloids, tranexamic acid, and uterine massage. 2)“Response to refractory PPH bundle” comprises continuous administration of uterotonics and isotonic crystalloids, second dose of tranexamic acid, compressive measures (aortic or bimanual uterine compression), the non-pneumatic anti-shock garment (NASG), and intrauterine balloon tamponade (IBT). The E-MOTIVE trial, led by the University of Birmingham and the WHO, is currently in progress to establish evidence and strategies to improve guideline adherence for the early detection of PPH and treatment using the WHO ‘first response’ bundle to improve outcomes.