Book
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
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- Delivery: Investigations & Cross Match |
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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. |
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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 |
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- Delivery: Prophylaxis at Cesarean Section |
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QS.2 |
All women with risk factors for PPH should be given IV Tranexamic acid at Cesarean Section (CS). |
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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 |
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- Delivery: Management of the 3rd Stage of Labor |
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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. |
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QM.3 |
Numerator: number of patients who received oxytocin (or misoprostol) within 1 minute of delivery of the baby. Denominator: total number of deliveries. |
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- Management of the Fourth Stage of Labor |
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QS.4 |
Vital signs and bleeding should be monitored and recorded every 15 mins in all women for the first two hours after birth. |
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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. |
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- PPH Management: Senior Staff Notification & Call |
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QS.5 |
When a woman presents with minor PPH, the required senior staff are notified and called as per protocol. |
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QM.5 |
Numerator: number of senior staff notified and called with minor PPH. Denominator: total number of women with minor PPH. |
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- PPH Mortality |
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QS.6 |
The majority of PPH mortalities are avoidable with proper preventive strategies and timely management by a multidisciplinary senior staff when needed. |
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QM.6 |
Numerator: number of women who died of PPH. Denominator: total number of women who developed PPH. |
