Identifying interventions to reduce peripartum haemorrhage associated with caesarean delivery in Africa: A Delphi consensus study

Jolene Moore, APORG Caesarean Delivery Haemorrhage Group, Bruce M Biccard* (Corresponding Author)

*Corresponding author for this work

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Women in Africa are fifty times more likely than in high-income settings to die following caesarean delivery, and peripartum haemorrhage is most strongly associated with mortality. We aimed to establish consensus on which interventions are considered most feasible to implement and most effective at reducing haemorrhage associated with caesarean delivery across Africa. We conducted a Delphi consensus study, including obstetric and anaesthesia providers from across Africa. In round one the expert group proposed key interventions for consideration. In rounds two and three the interventions were ranked on a 9-point Likert scale for effectiveness and feasibility. Round four was an online discussion to establish consensus on effectiveness and feasibility of interventions for which this had not been reached in round three. Twenty-eight interventions were considered both highly effective and feasible in Africa. Interventions covered a range of fields, categorised into direct- or indirect interventions. Direct interventions included: risk assessment and screening; checklists and protocols; monitoring and surveillance; availability of resources; ability to perform technical skills. Indirect interventions included: community and maternal education; contraception and family planning; minimum training standards; referral patterns and delays; advocacy to key stakeholders; simulation and team training; and 24-hour access to safe emergency caesarean delivery. Interventions considered both effective and feasible in reducing peripartum haemorrhage associated with caesarean delivery in Africa were identified. A multi-layered implementation strategy, including immediately developing a perioperative caesarean delivery bundle of care, in addition to longer-term public health measures may have a profound impact on maternal mortality in Africa.

Original languageEnglish
Article numbere0000455
Number of pages14
JournalPLOS Global Public Health
Issue number8
Publication statusPublished - 31 Aug 2022

Bibliographical note

Funding: SM acknowledges the South African Medical Research Council Mid-career Scientist Award. EHT acknowledges the Africa Oxford Initiative (AfiOx-188). The funders had no role in study design, data collection, data analysis, decision to publish, or preparation of the manuscript.

Data Availability Statement

Data are provided as part of the Supporting Information.


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