TABLE.

Suggested benchmarks for PPH protocol implementation

Benchmarks
For hemorrhage involving uterine atony, administration of a second uterotonic (after Pitocin) without delay once PPH is recognized, typically either methylergometrine or carboprost, unless contraindicated
For patients with PPH, administration of tranexamic acid as rapidly as feasible after diagnosis
For patients whose PPH is due to atony and is refractory to a second uterotonic, early placement of an intrauterine tamponade balloon (eg, Bakri balloon) or intrauterine vacuum device (eg, Jada device) before blood loss exceeds 1.5 L
Auditing of PPH cases to ensure teams are following PPH bundles and stage-based protocols, with corrective action plans to include reeducation and simulation when compliance is suboptimal, with escalation to processes, such as peer review reserved for cases in which specific providers do not alter practice patterns despite reeducation

PPH, postpartum hemorrhage.

Federspiel Postpartum hemorrhage protocols and benchmarks. Am J Obstet Gynecol MFM 2022.