The Development of Nursing Care System for Prevention Postpartum Hemorrhage

Abstract

Background: Postpartum hemorrhage is a public health problem which causes maternal death worldwide which one fourth of subsequent maternal death resulting from postpartum hemorrhage after the third stage of labor. The blood loss usually occurs within first 24 hours of postpartum period. Rate of postpartum hemorrhage has been steadily decreasing by year but remains a major problem of postpartum death in Thailand.
Objective: To study the effectiveness of developed nursing care system for postpartum hemorrhage prevention.
Study design: Action research was proposed to focus on maternal patients admitted to Buriram hospital from 2011 to 2013. Purposive sampling technique was used to recruit the subjects. The confer­ence of involved team was set to define cause of postpartum hemorrhage and review the relevant nursing practices for system improvement. The new nursing care system was applied to practice and evaluation. Descriptive data analysis presented with frequency, mean and percentage while qualitative statistics was used for content analysis.
Results: Situation analysis during 2011 to 2013 presented that Buriram Hospital had the explicit and standardized nursing care system for postpartum hemorrhage prevention in pregnant women and innovative measure blood bags was also invented. Network of postpartum hemorrhage prevention in pregnant women among community hospitals and primary care hospitals was established through the referrals system for continuous care. The study revealed rates of postpartum hemorrhage during 2011 to 2013 were 1.64%, 1.32% and 0.63% respectively while rate of postpar­tum hemorrhage shock were found 0.25%, 0.18% and 0.18% respectively. Incidence of maternal death from postpartum hem­orrhage was found in one case (14.10%) in 2012 and rates of hysterectomy according to postpartum hemorrhage were 0.20 %, 0.17% and 0.09% respectively.
Conclusion: According to the result of developed nursing care system for postpartum hemorrhage prevention, authors concluded that the new system for postpartum hemorrhage prevention was useful as a guideline for postpartum hemorrhage prevention which enhances multidisciplinary collaboration and seamless care between Buriram hospital and community hospital network.