Evaluating adherence to guideline-based quality indicators for postpartum hemorrhage care in the netherlands using video analysis

Mallory Woiski* (Corresponding Author), Suzan De Visser, Helena Van Vugt, Anneke Dijkman, Nico Schuitemaker, Claudia Van Meir, Johanna Middeldorp, Anjoke Huisjes, Ben W. Mol, Jan Molkenboer, Desiree Moonen-Delarue, Martijn Oudijk, Leonie Van Rheenen-Flach, Robert Rijnders, Paula Pernet, Martina Porath, Sander De Wit, Richard Grol, Hubertina Scheepers, Rosella Hermens

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

6 Citations (Scopus)


Objective: To assess adherence to the national postpartum hemorrhage guideline and Managing Obstetric Emergencies and Trauma course instructions and its determinants in the Netherlands. Methods: A prospective observational multicenter study in 16 Dutch hospitals analyzing data from medical records of 398 women at high risk for postpartum hemorrhage, of which 293 were supplemented with data from prospective video recordings. Adherence to guideline-based quality indicators for prevention, management, and organization of postpartum hemorrhage care was measured. Indicators for prevention and management of postpartum hemorrhage were categorized according to the amount of blood loss (less than 500, greater than 500, greater than 1,000, and greater than 2,000 mL). Results: Overall, a lack of adherence was observed, particularly for the actions to be undertaken with blood loss greater than 1,000 mL (69 patients). Actions were not or only taken in a later stage when the blood loss had already increased to greater than 2,000 mL (21 patients). In almost 41% (n5119/293) of the deliveries, no active management was performed, and in almost 80% (n589/112), vital signs were not monitored (blood loss greater than 500 mL) or monitored too late with respect to blood loss. The video recordings showed that in general the actual care given was considerably underreported in medical records. Postpartum hemorrhage care in the hospitals was well organized. Fifteen hospitals had a local postpartum hemorrhage protocol, and in 12 hospitals, team trainings were organized. Regarding the determinants high-risk patient identification and type of hospital (university vs nonuniversity hospital) were mostly associated with better adherence. Conclusion: This study showed low adherence to the guideline-based quality indicators, indicating a problem with Dutch quality care. The unique video observations provided additional, valuable information at which level improvement can be made. A tailor-made implementation strategy to improve quality of postpartum hemorrhage care has been developed.

Original languageEnglish
Pages (from-to)656-667
Number of pages12
JournalObstetrics and Gynecology
Issue number3
Publication statusPublished - 1 Sept 2018

Bibliographical note

Supported by the Netherlands Organization for Health Research and Development (ZonMw grant number No. 80-82315-98-09003).


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