Development of a Clinical Nursing Practice Guidelines to Prevention Postpartum hemorrhage in the first 2 hours after birth Rongkwang Hospital, Phrae Province

Abstract

Postpartum hemorrhage is the most common obstetric emergency and a major cause of maternal mortality worldwide, especially during the first 2 hours after birth. This research and development study aimed to Development of a Clinical Nursing Practice Guidelines to Prevention Postpartum hemorrhage in the first 2 hours after Birth at Rongkwang Hospital, Phrae Province, and evaluating the outcomes of the developed guidelines. The study was conducted in 3 phases: 1) Involved reviewing evidence-based practice development using the IOWA Model's 4 step process. The quality of the developed guidelines was assessed by 5 experts using the AGREE II instrument, achieving scores of over 80% in all domains and a CVI of 0.96 Furthermore, a questionnaire assessing registered nurses' opinions on the developed guideline for preventing early postpartum hemorrhage at Rongkwang Hospital achieved a CVI of 1.00. 2) Implemented the developed guidelines with two sample groups: (1) seven registered nurses in obstetric care, and (2) women who delivered vaginally at Rongkwang Hospital between October 2024 and March 2025. The sample size was determined to be 30 participants, divided into a control group and an experimental group (15 each). 3)Evaluate of the implementation. Data were analyzed using frequency, percentage, and the independent t-test to compare postpartum blood loss between the experimental and control groups. The results showed that the experimental group experienced significantly less blood loss than the control group during both the first 2 and 24 hours postpartum. No cases of PPH were found in the experimental group, while the control group had an incidence of 6.7%. Registered nurses expressed the highest level of agreement with the use of the guidelines. This study demonstrates that the developed nursing practice guidelines effectively prevent postpartum hemorrhage in the first 2 hours after birth and can be utilized as a standard nursing protocol.