Clinical audit of postpartum hemorrhage at district-level and referral-level hospitals in southern Thailand

Abstract

Objective: Assess the management and clinical outcomes of women diagnosed immediate PPH in three referral hospitals and six district hospitals in southern Thailand. Material and Method: A cross-sectional study was done in participated hospital. Medical records of eligible cases were reviewed for management using evidence-based checklist. The adherence to each item of managements and the association between the management and related morbidities were analyzed. Results: Medical records of 360 cases were assessed. Low adherence of retaining Foley catheter (44%) and close hemodynamic monitoring (67%) was found at district level. Retaining Foley catheter was demonstrated at referral level in 76% but performing uterine massage was documented in 67%. The adherence of managements was more likely to be found in cases with severe blood loss or received blood transfusion. Conclusion: Although low incidence of PPH was reported, incidence of blood transfusion, hypovolemic shock, and hysterectomy were not uncommon. Suboptimal care for hemodynamic monitoring and incomplete documentation of treatment need to be improved.