Development of Clinical Practice Guideline for Early Postpartum Hemorrhage in Labor Room, Lamphun Hospital

Abstract

This research and development study aimed to develop clinical nursing practice guideline to prevent early postpartum hemorrhage and study of the effectiveness of the clinical nursing practice guideline to prevent early postpartum hemorrhage in labor room, Lamphun Hospital on the incidence of postpartum hemorrhage and complications. The samples consisted of 10 nurses working in the labor room and 798 mothers who were at risk of having postpartum hemorrhage. The research instruments were: a PPH assessment form, the developed CNPG and the CNPG evaluation form. The tools used to collect data are questionnaires. The data were analyzed using content analysis and descriptive statistics include frequency, percentage, mean and standard deviation. The results revealed as following;

1. The CNPG for preventing early postpartum hemorrhage included the three following phases: 1) Antenatal phase guidelines proceed history taking, assessment of PPH using 4Ts, blood test for CBC and using partograph for maternal care. 2) Labor phase guidelines perform urinary catheter, follow up signs, restrict episiotomy, doing active management of the third stage of labor and use a blood pressure bleeding bag to reduce the level of 300 ml to monitor postpartum depression using 4Ts. 3) Providing postpartum nursing care, postpartum care for the first 2 hours in labor room, massage the uterus, breast feeding and care before moving to the obstetric ward.
2. The effectiveness of the clinical nursing practice guideline to prevent early postpartum hemorrhage found presented that the postpartum hemorrhage rate was decreased from 3.02% in 2015 to 2.62% in 2016 as significantly. There was no incidence of hypovolemic shock, hysterectomy and maternal death from the postpartum hemorrhage after using this clinical nursing practice guideline. Using the CNPG for preventing early postpartum hemorrhage included overall, nurses had a view to applying the CNPG for preventing early postpartum hemorrhage in labor room, Lamphun Hospital at the high level.

In conclusion, the CNPG for early PPH prevention should be implemented to prevent the early PPH, especially for a serious complication of PPH.

 Postpartum hemorrhage, Clinical Nursing Practice Guideline, effectiveness of the Clinical Practice Guidelines