gms | German Medical Science

Objective: Post-Partum Hemorrhage (PPH) still has a rising incidence in high-resource countries despite the existing PPH-guidelines. Insight in different levels of actual PPH-care is necessary to detect factors to improve implementation. The purpose of this study is to access the organizational structure in the actual PPH-care in The Netherlands, using guideline-based organizational indicators.

Method: The organizational component of the actual PPH-care in The Netherlands was assessed by means of a web-based questionnaire, based on valid guideline-based organizational-indicators. The questionnaire was send to the obstetric-gynecologists of 16 different types of hospitals, of which 4 university (UH), 8 teaching (TH) and 4 non-teaching hospitals (NT).

Results: Results gained from 11 responding obstetric-gynecologists showed a 65% overall adherence to the quality-indicators. Jehovah-witnesses and shock-protocols were absent in 55% and 45% of the hospitals, of which 0% and 33% in the NT. 82% of the hospitals provided team-training, of which 56% less than once per 2 months. Only a few hospitals had a 24/7 presence of a gynaecologists (18%) and anesthesiologist/OR-team (27%). Complication-discussions were held in 64%, and a small number of hospitals contained written multidisciplinary arrangements for PPH-treatment with the anesthetists (36%), hematologists (20%), and intervention-radiologists(11%).

Discussion: Adherence to the organizational-indicators is variable in the Dutch PPH-care, still several important factors, such as multidisciplinary arrangements for PPH-treatment and the presence of a hospital-wide shock-protocol, remain to be improved. These results will be used in a multilevel tailor-made approach to improve PPH-care in The Netherlands.