Table 3.
Summary of blood loss thresholds and vital sign changes for detection of postpartum haemorrhage according to healthcare providers (N = 45) in Kenya, Nigeria, and South Africa.
| Country | Primary PPHa following vaginal birth | Severe PPH following vaginal birth | Vital sign Changes | Protocols/ guidelines/ Standard operation procedure followed | Method used for PPH detection and equipment used for quantifying blood loss for PPH at different hospitals |
|---|---|---|---|---|---|
| Kenya | ≥500 ml blood loss within 24 h | ≥1,000 ml of blood loss | Any blood loss that has the potential to produce haemodynamic instability should be considered a PPHa. | International guidelines (World Health Organization) Local guidelines provided by the Ministry of Health |
Visual estimation on and underneath bed. Equipment/ supplies: Linen/ Maternity pads/ Gauze If 4-5 pads are used in an hour after childbirth that is considered PPH Measuring jar |
| Nigeria | ≥500 ml blood loss within 24 h following childbirth any bleeding that can affect the PCVa more than 10% | Threshold for blood loss ranges from 1,000 ml to 2,500 ml | Any blood loss that has the potential to produce haemodynamic instability (decreased BP, increased PR, rapid breathing) should be considered a PPHa. The woman will exhibit instability in physical state (pallor, dizziness, fainting, shock) | Royal College of Obstetricians and Gynaecologists (RCOG) Local guidelines adapted from international guidelines |
Visual estimation on and underneath bed. Equipment/ supplies: Wrappers, Sanitary or maternity pads or under pads Gauze; Kidney dishes or measuring jug. Waterproof delivery mat |
| South Africa | ≥500 ml blood loss within 24 h | ≥1,000 ml of blood loss | PRa and BPa are normal until blood loss exceeds 1000 ml; tachycardia, tachypnoea; fall in BPa with 1000-1500 ml blood loss; rapid PR; worsening tachycardia, tachypnoea, and exhibiting instability in physical state (pale, dizziness, fainting, shock) | National guideline adapted from international guidelines for PPH (such as RCOG) ESMOE algorithm |
Visual estimation of blood loss on and underneath bed. Equipment/ supplies: Maternity pads + Linen savers (One linen saver estimated to soak about 300-500 ml blood. |
a
PPH, postpartum haemorrhage; PCV: packed cell volume; BP, Blood pressure; PR, Pulse rate; RCOG, Royal College of Obstetricians and Gynaecologists; ESMOE, Essential Steps in the Management of Obstetric Emergencies.