The The results of using guidelines to prevent postpartum hemorrhage in mothers who give birth normally. Somdej Phra Yupparat Wiangsa Hospital Surat Thani Province

Abstract

Postpartum hemorrhage (PPH) is a major obstetric emergency and one of the leading causes of maternal mortality worldwide. Data from Somdet Phra Yupparaj Wiang Sa Hospital during 2021–2023 revealed postpartum hemorrhage rates of 7.3%, 5.7%, and 5.4% respectively, which did not meet quality standards. The main causes included uterine atony, retained placenta, and genital tract trauma. This study aimed to develop and evaluate the implementation of a clinical practice guideline to prevent postpartum hemorrhage among normal vaginal deliveries by applying the PDCA quality improvement framework. The study was conducted in three phases: (1) situation analysis through medical record review and brainstorming with delivery room nurses to identify problems and areas for improvement, (2) development of a prevention system by modifying risk assessment forms, establishing standardized nursing practices, and improving communication and referral systems, and (3) evaluation of outcomes. Participants included six professional nurses in the delivery room and 40 postpartum mothers from November 2024 to July 2025. Research instruments consisted of demographic questionnaires, nurse opinion and satisfaction surveys, nursing practice assessment forms, and postpartum hemorrhage incident reports. Data were analyzed using descriptive statistics and pre–post comparison of hemorrhage rates.
Results: Nurses correctly followed the practice guideline at a high level (≥85%). Overall satisfaction toward the guideline was rated as high (mean = 3.0 ). The postpartum hemorrhage rate decreased from 6.8% before the intervention to 3.2% after the implementation. No cases of severe complications such as hemorrhagic shock, hysterectomy, or maternal death were reported. These findings are consistent with recent studies confirming the effectiveness of Active Management of the Third Stage of Labor (AMTSL) in reducing PPH and enhancing maternal safety