gms | German Medical Science

G-I-N Conference 2012

Guidelines International Network

22.08 - 25.08.2012, Berlin

Poor translation of the nation-wide postpartum hemorrhage guideline and MOET-instructions into local protocols (the Fluxim study)

Meeting Abstract

  • M. van Vugt - Departement of Obstetrics and Gynaecology, Radboud University Nijmegen, Nijmegen, The Netherlands
  • M. Woiski - Departement of Obstetrics and Gynaecology, Radboud University Nijmegen, Nijmegen, The Netherlands
  • L. Scheepers - Departement of Obstetrics and Gynaecology, University Medical Centre Maastricht, Maastricht, The Netherlands
  • R. Hermens - IQ Healthcare, Radboud University Nijmegen, Nijmegen, The Netherlands

Guidelines International Network. G-I-N Conference 2012. Berlin, 22.-25.08.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocP176

doi: 10.3205/12gin288, urn:nbn:de:0183-12gin2888

Published: July 10, 2012

© 2012 van Vugt et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: Post-Partum Hemorrhage (PPH) continuous having a rising incidence in developed countries. The aim of this study was to evaluate the degree of implementation of the Dutch PPH-guideline and the Managing Obstetric Emergency Trauma (MOET)-instructions into local hospital protocols, next to the protocol-structure.

Methods: 18 local PPH-protocols (3 university (UH), 7 teaching (TH) and 8 non-teaching (NT)) were derived throughout The Netherlands. From 37 valid guideline-based indicators, 82 items were used to determine the degree of implementation. The presence of an item and the corresponding time-indication was measured. The AGREE-instrument was used to assess the structure of the protocols.

Results: Overall implementation of the indicators was 46%, with a highest score of 68% (UH) and a lowest of 18% (NT). Indicators with their corresponding time-indications were mentioned in 23% of the protocols. Even the key-recommendation for all deliveries, which is; active management of labor, was present in only 33% of the protocols. Less than 50% of the protocols had a structure according to the AGREE-instrument.

Discussion and implication GL-developers/users: This study shows that in The Netherlands, the first step in implementation of the national PPH-guideline and MOET-instructions is not optimal. Care is presumed to follow the content of the local protocol, containing a clear structure. Therefore, we expect poor adherence to the guideline/course-instructions. Proper implementation is essential for good adherence in care, so measurement of the actual care will be the next step in the improvement strategy of PPH-care