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Primary Postpartum Hemorrhage

- Research needs

Epidemiology of PPH in Egypt

  • Accurate national and regional incidence and mortality data.
  • Risk factor profiles among Egyptian women, including the role of anaemia, high parity, and caesarean section rates.

Early recognition, Health System Capacity & Implementation

  • Validation study for early obstetric warning score (EOWS) trigger chart, considering feasibility as an objective maternity evaluation and monitoring tool compared to use of vital data subjectively.
  • Study to evaluate MEOWS optimum trigger values and optimum response to abnormal score.
  • Effectiveness of active management of the third stage of labour (AMTSL) across different levels of healthcare (primary, secondary, tertiary).
  • Barriers to timely administration of uterotonics, tranexamic acid, and blood products in Egyptian hospitals.
  • Evaluation of referral pathways and emergency obstetric transport systems in rural vs. urban settings.

Pharmacological & Non-Pharmacological Interventions

  • Comparative effectiveness of oxytocin, misoprostol, and carbetocin in Egyptian populations, considering cost-effectiveness and storage challenges.
  • Feasibility and outcomes of balloon tamponade, B-Lynch sutures, and interventional radiology in resource-variable settings.

Blood Management and Transfusion Practices

  • Outcomes of implementing Massive Transfusion Protocols (MTP) in Egyptian obstetric units.
  • Strategies to optimize blood availability, cross-matching practices, and patient blood management in maternity care.

Maternal Health Determinants

  • Impact of nutritional anemia, chronic diseases, and social determinants (access, literacy, socioeconomic status) on PPH outcomes.
  • Cultural and behavioral factors influencing care-seeking and acceptance of interventions.

Training and Simulation-Based Research

  • Effectiveness of structured training programs, PPH emergency drills, and multidisciplinary team simulations in reducing delays and errors in real practice.

Cost-Effectiveness and Health Economics

  • Economic evaluation of different uterotonics, surgical techniques, and emergency interventions in Egyptian hospitals.
  • Budget impact of scaling up WHO-recommended interventions at national level.

Clinical Quality Standards for Monitoring

- Delivery: Investigations & Cross Match

QS.1

All women with one or more risk factors for PPH should have an IV line with 16 G canula, and blood sample sent for CBC, blood group, and cross match of 2 units of blood.

QM.1

Numerator: number of women with risk factors admitted to labor who have an IV access (16G) and a sample of blood sent for CBC, blood group, and cross match of 2 units of blood.

Denominator: total number of women with risk factors admitted to labor

 

- Delivery: Prophylaxis at Cesarean Section

QS.2

All women with risk factors for PPH should be given IV Tranexamic acid at Cesarean Section (CS).

QM.2

Numerator: number of women with risk factors for PPH given IV Tranexamic acid at CS

Denominator: number of women with risk factors for PPH who had CS

 

- Delivery: Management of the 3rd Stage of Labor

QS.3

All women after delivery of the baby are given oxytocin, or misoprostol if oxytocin is not available, within one minute maximally of delivery of the baby.

QM.3

Numerator: number of patients who received oxytocin (or misoprostol) within 1 minute of delivery of the baby.

Denominator: total number of deliveries.

 

- Management of the Fourth Stage of Labor

QS.4

Vital signs and bleeding should be monitored and recorded every 15 mins in all women for the first two hours after birth.

QM.4

Numerator: number of women monitored for vital signs and bleeding in the first 2 hours after birth and data recorded in their file.

Denominator: total number of women who gave birth.

 

- PPH Management: Senior Staff Notification & Call

QS.5

When a woman presents with minor PPH, the required senior staff are notified and called as per protocol.

QM.5

Numerator: number of senior staff notified and called with minor PPH.

Denominator: total number of women with minor PPH.

 

- PPH Mortality

QS.6

The majority of PPH mortalities are avoidable with proper preventive strategies and timely management by a multidisciplinary senior staff when needed.

QM.6

Numerator: number of women who died of PPH.

Denominator: total number of women who developed PPH.