Development of system for prevention and management of early postpartum hemorrhage following vaginal delivery at Pakchong Nana Hospital

Abstract

The objective of this research was to develop a preventive care system for postpartum hemorrhage after vaginal delivery at Pakchong Nana Hospital. It comprised 4 steps, 1) analysis of the conventional system, 2) new system design, 3) new system development, and 4) new system evaluation. The sample groups for evaluation were categorized as control groups and test groups, and each groups consisted of 43 pregnancies. The research instrument included 1) new system developed and 2) data collection sheet. The data were expressed with descriptive statistics, and risks were analyzed with correlation coefficient and logistic regression and compared with T-test.

The results showed that the main causes of postpartum hemorrhage were the uterine atony, birth canal tear, inadequately trained staff and indistinct practical guideline. Factors positively associating with postpartum hemorrhage with statistical significance were non-Thai nationality, history of medical illnesses, history of uterine curettage, prolonged first, second and third stages of labor and the integrity of the placenta. The factors predicting the postpartum hemorrhage included history of uterine curettage, prolonged first and second stages of labor, integrity of the placenta with 91.9 % accuracy.

The new system development comprised; personnel side: increased nurses’ performance, procedure side: improved screening for pregnancies at risk for postpartum hemorrhage at every stage, promoting the usage of active management practice conclusively and early management for blood loss 300 ml and innovation in blood collector bag. The test group under new system implementation showed no hemorrhage, shortened duration of second stage of labor, less blood loss and higher hematocrit level with statistical significance as compared with the control group under the conventional system.

It should be concluded that the new system of prevention and management of postpartum hemorrhage after vaginal delivery at Pakchong Nana Hospital could efficiently prevent the postpartum hemorrhage and its complications.