Clinical Audit of Postpartum Hemorrhage at District-Level
and Referral-Level Hospitals in Southern Thailand
Pattarawalai Talungchit MD*,
Tippawan Liabsuetrakul MD, PhD**
Affiliation :
* Department of Obstetrics and Gynecology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
** Epidemiology unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
Objective : Assess the management and clinical outcomes of women diagnosed immediate PPH in three referral hospitals
and six district hospitals in southern Thailand.
Material and Method: A cross-sectional study was done in participated hospital. Medical records of eligible cases were
reviewed for management using evidence-based checklist. The adherence to each item of managements and the association
between the management and related morbidities were analyzed.
Results : Medical records of 360 cases were assessed. Low adherence of retaining Foley catheter (44%) and close
hemodynamic monitoring (67%) was found at district level. Retaining Foley catheter was demonstrated at referral level in
76% but performing uterine massage was documented in 67%. The adherence of managements was more likely to be found
in cases with severe blood loss or received blood transfusion.
Conclusion : Although low incidence of PPH was reported, incidence of blood transfusion, hypovolemic shock, and
hysterectomy were not uncommon. Suboptimal care for hemodynamic monitoring and incomplete documentation of treatment
need to be improved.
Keywords : Clinical audit, Postpartum hemorrhage, Quality of care, Management
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