WHO guidelines for the management of postpartum haemorrhage ...

Contents
Background 1
Methods 2
Scope of the guidelines 3
Evidence and recommendations 4
A. Diagnosis of PPH 4
1. Should blood loss be routinely quantified during management of the third stage of
labour for the purpose of diagnosing PPH? 4
B. Management of atonic PPH 5
1. Medical interventions for management of PPH 5
2. Non-medical interventions for management of PPH 12
3. Surgical interventions in the treatment of PPH 16
C. Management of retained placenta 17
1. Should uterotonics be offered as treatment for retained placenta? 17
2. Should intra-umbilical vein injection of oxytocin with or without saline be offered
as treatment for retained placenta? 18
3. Should antibiotics be offered after manual extraction of the placenta as part of the
treatment of retained placenta? 19
D. Choice of fluid for replacement or resuscitation 20
1. Should crystalloids be offered for fluid replacement in women with PPH? 20
E. Health systems and organizational interventions 21
1. Should health care facilities have a protocol for management of PPH? 21
2. Should health care facilities have a formal protocol for referral of women
diagnosed as having PPH? 21
3. Should simulation of PPH treatment be part of training programmes for
health care providers? 22
PPH care pathways 22
Research Implications 24
Plans for local adaptation of the recommendations 26
Plans for supporting implementation of these recommendations 26
GRADE tables 26
A. Diagnosis of PPH 27
B. Management of atonic PPH 28
C. Management of retained placenta 33
D. Choice of fluid for replacement or resuscitation 38
References 40
Annex 1. Scoping document with average scores 47
Annex 2. Search strategy 50
Annex 3. GRADE methodology 51
Annex 4. List of participants 54