A System for the Prevention and Management of Postpartum Hemorrhage (PPH) among Mothers with Normal Vaginal Delivery in the Context of Thailand’s Southern Border Provinces

Abstract

Postpartum hemorrhage (PPH) is a major cause of maternal mortality in Thailand’s southern border provinces, particularly in the Narathiwat Province. This area faces unique challenges related to resources, security, culture, and religious beliefs, which affects both access and quality of maternal and child health services. This article aimed to present a prevention and treatment system for PPH among mothers with normal vaginal delivery in the context of Thailand’s southern border provinces. An integrative knowledge review was combined with an analysis of empirical data from actual healthcare services in Narathiwat Province, including maternal mortality reports, root cause analyses, retrospective medical record reviews, and multidisciplinary team brainstorming. Results were synthesized with international clinical guidelines to design a new system, more adapted to the local context. The developed system comprised six components: 1) establishment of a provincial system development committee, 2) systematic assessment and analysis of problems, 3) development of a screening and follow-up system for high-risk pregnant women, 4) development of clinical practice guidelines (CPGs), 5) establishment of a PPH rapid response team, and 6) development of the PPH emergency response cart innovation. Following implementation, the PPH rate decreased from 0.90% to 0.70%, while the rate of PPH-related shock decreased from 13.82% to 11.11%, and the rate of antenatal anemia decreased from 23.70% to 16.27%. In conclusion, the developed system can demonstrably reduce the incidence of maternal complications and mortality through the integration of empirical evidence, international guidelines, and understanding of the local cultural context. The system represents a potentially scalable model for implementation in other provinces.