@article{fdi:010091086,
  title = {{S}trategies for optimising early detection and obstetric first response management of postpartum haemorrhage at caesarean birth : a modified {D}elphi-based international expert consensus},
  author = {{P}ingray, {V}. and {W}illiams, {C}. {R}. and {A}l-beity, {F}. {M}. {A}. and {A}balos, {E}. and {A}rulkumaran, {S}. and {B}lumenfeld, {A}. and {C}arvalho, {B}. and {D}eneux-{T}haraux, {C}. and {D}owne, {S}. and {D}umont, {A}lexandre and {E}scobar, {M}. {F}. and {E}vans, {C}. and {F}awcus, {S}. and {G}aladanci, {H}. {S}. and {H}oang, {D}. {T}. {T}. and {H}ofmeyr, {G}. {J}. and {H}omer, {C}. and {L}ewis, {A}. {G}. and {L}iabsuetrakul, {T}. and {L}umbiganon, {P}. and {M}ain, {E}. {K}. and {M}aua, {J}. and {M}uriithi, {F}. {G}. and {N}abhan, {A}. {F}. and {N}unes, {I}. and {O}rtega, {V}. and {P}han, {T}. {N}. {Q}. and {Q}ureshi, {Z}. {P}. and {S}osa, {C}. and {V}arallo, {J}. and {W}eeks, {A}. {D}. and {W}idmer, {M}. and {O}ladapo, {O}. {T}. and {G}allos, {I}. and {C}oomarasamy, {A}. and {M}iller, {S}. and {A}lthabe, {F}.},
  editor = {},
  language = {{ENG}},
  abstract = {{O}bjective {T}here are no globally agreed on strategies on early detection and first response management of postpartum haemorrhage ({PPH}) during and after caesarean birth. {O}ur study aimed to develop an international expert's consensus on evidence-based approaches for early detection and obstetric first response management of {PPH} intraoperatively and postoperatively in caesarean birth. {D}esign {S}ystematic review and three-stage modified {D}elphi expert consensus. {S}etting {I}nternational.{P}opulation {P}anel of 22 global experts in {PPH} with diverse backgrounds, and gender, professional and geographic balance.{O}utcome measures {A}greement or disagreement on strategies for early detection and first response management of {PPH} at caesarean birth.{R}esults {E}xperts agreed that the same {PPH} definition should apply to both vaginal and caesarean birth. {F}or the intraoperative phase, the experts agreed that early detection should be accomplished via quantitative blood loss measurement, complemented by monitoring the woman's haemodynamic status; and that first response should be triggered once the woman loses at least 500 m{L} of blood with continued bleeding or when she exhibits clinical signs of haemodynamic instability, whichever occurs first. {F}or the first response, experts agreed on immediate administration of uterotonics and tranexamic acid, examination to determine aetiology and rapid initiation of cause-specific responses. {I}n the postoperative phase, the experts agreed that caesarean birth-related {PPH} should be detected primarily via frequently monitoring the woman's haemodynamic status and clinical signs and symptoms of internal bleeding, supplemented by cumulative blood loss assessment performed quantitatively or by visual estimation. {P}ostoperative first response was determined to require an individualised approach. {C}onclusion {T}hese agreed on proposed approaches could help improve the detection of {PPH} in the intraoperative and postoperative phases of caesarean birth and the first response management of intraoperative {PPH}. {D}etermining how best to implement these strategies is a critical next step.},
  keywords = {obstetrics ; maternal medicine ; postpartum period ; systematic review ; clinical decision-making},
  booktitle = {},
  journal = {{BMJ} {O}pen},
  volume = {14},
  numero = {5},
  pages = {e079713 [12 p.]},
  ISSN = {2044-6055},
  year = {2024},
  DOI = {10.1136/bmjopen-2023-079713},
  URL = {https://www.documentation.ird.fr/hor/fdi:010091086},
}