Hemorrhagia postpartum: an implementationstudy on the NVOG guidelines and MOET instructions
01 / 2009 - 12 / 2012
Website IQ Healthcare
Objective: The most important cause of maternal morbidity in the Netherlands is Hemorrhagia post partum (HPP), with an incidence of 5% containing 10.000 women in the Netherlands a year. Introduction of an evidence-based guideline about HPP by the Dutch society of Obstetrics and Gynaecology (NVOG) and the course Management of Obstetrics Emergencies and Trauma (MOET course) did not lead to a reduction in HPP. This implies the possibility of an incomplete implementation of both the NVOG guideline and MOET-instructions. Study design: To evaluate the implementation of the guideline and MOET instruction in the current care, measurement of the actual care will be performed in a representative sample of 20 hospitals. This will be done by prospective observation of the third stage of labor of 400 women with a high risk of HPP by using quality indicators extracted from the NVOG guideline and MOET instructions. Barriers an facilitators for the guideline adherence will be analyzed by performance of semi structured interviews with 30 professionals and 10 patients and a questionnaire among all Dutch gynaecologists and midwives. In a feasibility study in 4 hospitals a tailor made strategy to implement the NVOG guideline and MOET instructions, based on the outcome of the two studies above, will be tested. In this feasibility study an effect-, process- and cost-evaluation will be performed. Study population: All women with a higher risk of HPP: -HPP in previous delivery; -multiple pregnancy; -polyhydramnion; -chorio-amnionitis; -uterus myomatosis; -grande multyparity; -long delivery; -clotting disorders; -thrombocytopenia (HELLP).