Development of a Clinical Nursing Practice Guideline to Prevent Early Postpartum Hemorrhage for Vaginal Delivery in a Labor Room, Songkhla Hospital

Abstract

The objectives of this study were to develop a nursing practice guideline for the prevention of early postpartum hemorrhage among mothers who had a vaginal birth and to examine the outcomes after applying the guideline. This guideline included 3 stages: 1) the preparation; 2) the implementation; and 3) the evaluation. Participants were nurses who used the guideline and 56 mothers who had given birth within the previous 2 hours. The research tool was the nursing practice guideline for preventing early postpartum hemorrhage for vaginal delivery. The data collection tools included the medical record review form, the guideline assessment, and the 2-hour postpartum hemorrhage assessment. Data was analyzed and used to create a nursing practice guideline. Three experts conducted an accuracy test and the result of an accuracy test between the assessors was 0.95. The Cronbach’s alpha coefficient of the 2-hour postpartum hemorrhage assessment was 0.89. Data were analyzed using descriptive analysis and one sample t-test.

The results showed that a nursing practice guideline for the prevention of early postpartum hemorrhage for vaginal delivery in Songkhla Hospital consists of 4 steps: 1) assessment of warning signs of postpartum hemorrhage up to 2 hours of postpartum; 2) postpartum massage; 3)1-hour postpartum blood volume assessment; and 4) 2-hour postpartum blood volume assessment. After applying this guideline, it was found that postpartum hemorrhages decreased significantly, with less than 500 cc (p-value= 0.001). 96.43% of mothers had good contractions, normal vital signs, and no postpartum abnormalities. In practice, nurses reported that this guideline was easy to understand and appropriate to use for preventing early postpartum hemorrhages. It can be concluded that this guideline is effective for the prevention of early postpartum hemorrhage among mothers who had a vaginal birth. Nurses in other health care centers can implement this nursing practice guideline effectively.