From Postpartum Haemorrhage Guideline to Local Protocol: A Study of Protocol Quality

Mallory D. Woiski*, Helena C. van Vugt, Anneke Dijkman, Richard P. Grol, Abraham Marcus, Johanna M. Middeldorp, Ben W. Mol, Femke Mols, Martijn A. Oudijk, Martina Porath, Hubertina J. Scheepers, Rosella P. Hermens

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

5 Citations (Scopus)


Objective Postpartum hemorrhage (PPH) has a continuously rising incidence worldwide, suggesting suboptimal care. An important step in optimizing care is the translation of evidence-based guidelines into comprehensive hospital protocols. However, knowledge about the quality of these protocols is lacking. The objective of this study was to evaluate the quality of PPH-protocols on structure and content in the Netherlands. Methods We performed an observational multicenter study. Eighteen PPH-protocols from 3 University Hospitals (UH), 8 Teaching Hospitals (TH) and 7 Non-Teaching hospitals (NTH) throughout the Netherlands were acquired. The structure of the PPH-protocols was assessed using the Appraisal of Guidelines for Research and Evaluation (AGREE-II) Instrument. The content was appraised using previously developed quality indicators, based on international guidelines and Advance-Trauma-Life-Support (ATLS)-based course instructions. Results The quality of the protocols for postpartum hemorrhage for both structure and content varied widely between different hospitals, but all of them showed room for improvement. The protocols scored mainly below average on the different items of the AGREE-II instrument (8 of the 10 items scored <4 on a 1–7 scale). Regarding the content, adoption of guideline recommendations in protocols was 46 %. In addition, a timely indication of ‘when to perform’ a recommendation was lacking in three-fourths of the items. Conclusion This study shows that the quality of the PPH-protocols for both structure and content in the Netherlands is suboptimal. This makes adherence to the guideline and ATLS-based course instructions difficult.

Original languageEnglish
Pages (from-to)2160-2168
Number of pages9
JournalMaternal and Child Health Journal
Issue number10
Early online date9 Jul 2016
Publication statusPublished - Oct 2016


  • Clinical protocols
  • Guideline adherence
  • Health care quality access and evaluation
  • Postpartum hemorrhage


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