Evidence summary of best practices for prevention and management of postpartum hemorrhage in obstetric clinical practice

Objective: To search, evaluate, and synthesize the best available evidence for the prevention of postpartum hemorrhage (PPH). This study summarizes the key recommendations of evidence-based nursing for the prevention and management of PPH in obstetrics, aiming to guide clinical practice. Methods: The PIPOST framework was employed to comprehensively define the evidence-based question across six dimensions: Population, Intervention, Professionals, Outcome, Setting, and Type of evidence, ensuring scientific rigor and relevance. A top-down systematic search was conducted following the "6S" pyramid evidence model, encompassing authoritative international and domestic resources, including computerized decision support systems, guideline repositories, professional society websites, and major databases. Diverse evidence types, such as clinical decisions, guidelines, and systematic reviews, were included to provide comprehensive coverage of PPH prevention strategies. The quality of the eligible literature was rigorously appraised, and the guidelines were evaluated using the for Appraisal of Guidelines Research, Evaluation, and Education Development II instrument to ensure reliability and validity. Key information related to PPH prevention was then extracted. Finally, the evidence was graded based on quality and reliability to provide a clear foundation for evidence-based practice and assist healthcare professionals in selecting appropriate interventions. Thirteen publications were ultimately included, comprising two guidelines, two expert consensuses, one evidence summary, three nursing and survey studies, one systematic review, and three review articles. Twenty-three best practice recommendations for PPH prevention and management were systematically synthesized across 11 domains: risk assessment, anemia management, health education, mode of delivery selection, oxytocin administration, active management of the third stage of labor, labor control, vital signs monitoring, vaginal blood loss monitoring, uterine contraction monitoring, and psychological care. Conclusion: Clinical administrators bear significant responsibility and should focus on refining the emergency management protocols for severe PPH. Therefore, it is crucial to vigorously promote the standardization and systematic training of healthcare professionals. Through diverse training formats and specialized courses, the professional competence and practical skills of clinical staff in preventing and managing PPH can be effectively enhanced. This enables more effective handling of PPH cases in clinical practice, potentially reducing its incidence and associated mortality, thereby providing a more robust safeguard for maternal health. Significance: By systematically searching and synthesizing authoritative domestic and international resources, this study summarizes 23 best practice recommendations for PPH prevention and management. This assists nursing staff in conducting better nursing assessments, diagnoses, and planning, formulating scientific and effective nursing interventions, improving workflows, and addressing existing and potential patient problems, thereby promoting scientific and effective clinical nursing practice. Scope of application: Applicable to parturients with bleeding tendencies, for the prevention of PPH, and to assist healthcare workers in developing scientific and effective medical and nursing measures.