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ObjectiveTo systematically develop evidence-based bundles for care of postpartum hemorrhage (PPH).MethodsAn international technical consultation was conducted in 2017 to develop draft bundles of clinical interventions for PPH taken from the WHO's 2012 and 2017 PPH recommendations and based on the validated "GRADE Evidence-to-Decision" framework. Twenty-three global maternal-health experts participated in the development process, which was informed by a systematic literature search on bundle definitions, designs, and implementation experiences. Over a 6-month period, the expert panel met online and via teleconferences, culminating in a 2-day in-person meeting.ResultsThe consultation led to the definition of two care bundles for facility implementation. The "first response to PPH bundle" comprises uterotonics, isotonic crystalloids, tranexamic acid, and uterine massage. The "response to refractory PPH bundle" comprises compressive measures (aortic or bimanual uterine compression), the non-pneumatic antishock garment, and intrauterine balloon tamponade (IBT). Advocacy, training, teamwork, communication, and use of best clinical practices were defined as PPH bundle supporting elements.ConclusionFor the first response bundle, further research should assess its feasibility, acceptability, and effectiveness; and identify optimal implementation strategies. For the response to refractory bundle, further research should address pending controversies, including the operational definition of refractory PPH and effectiveness of IBT devices.

The overall aim of the project was to study pregnant women's knowledge of danger signs during pregnancy and childbirth and actions taken in case danger signs occurred. Both quantitative and qualitative methods were used. A questionnaire was administered at the antenatal care clinic (ANC). Non-participant observations of the midwives at the ANC were also performed. Individual interviews were conducted with pregnant and newly delivered women as well as with clinical officers. A retrospective study of maternity records was also conducted. A majority of the women attended their first ANC visit late in the pregnancy. Women's general knowledge of danger signs was low. A lack of discrepancy between common pregnancy related and dangerous symptoms was noted. The observations revealed that little or no health education concerning danger signs were given and inadequate examination of the women were conducted. The ANC reaches around 92% off the pregnant women. This provides an ideal opportunity for information on danger signs and when and where to seek care. It is important to encourage early ANC attendance and complete examinations in order to identify high-risk pregnancies and prevent treatable illnesses. [ABSTRACT FROM AUTHOR]