Variations in Postpartum Hemorrhage Management among Midwives: A National Vignette-Based Study

摘要: Objective To assess variations in adherence to guidelines for management of postpartum hemorrhage (PPH) among midwives. Methods A multicentre vignette-based study was e-mailed a random sample midwives from 145 maternity units France. They were asked describe how they would manage the PPH described 2 case-vignettes. These previously validated case-vignettes different scenarios severe PPH. Vignette 1 typical immediate, and vignette less case but gradual constructed 3 successive steps included multiple-choice questions proposing several types clinical practice options at each step. An expert consensus defined 14 criteria assessing issued by French College Obstetricians Gynecologists 2004 midwives’ responses. We analyzed number errors quantify level adherence. Results We obtained 450 complete responses 87 units. The rate (no error any criteria) low: 25.1% 4.2% 2. higher pharmacological management, especially oxytocin use, than non-pharmacological communication-monitoring-investigation. Adherence varied substantially between within units, as well vignettes same midwives. Conclusion Reponses demonstrated substantial individual guidelines. Midwives should participate continuous individualized training.