Postpartum hemorrhage care bundles to improve adherence to guidelines: A <scp>WHO</scp> technical consultation

<jats:title>Abstract</jats:title><jats:sec><jats:title>Objective</jats:title><jats:p>To systematically develop evidence‐based bundles for care of postpartum hemorrhage (<jats:styled-content style="fixed-case">PPH</jats:styled-content>).</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>An international technical consultation was conducted in 2017 to develop draft bundles of clinical interventions for <jats:styled-content style="fixed-case">PPH</jats:styled-content> taken from the <jats:styled-content style="fixed-case">WHO</jats:styled-content>'s 2012 and 2017 <jats:styled-content style="fixed-case">PPH</jats:styled-content> recommendations and based on the validated “<jats:styled-content style="fixed-case">GRADE</jats:styled-content> Evidence‐to‐Decision” framework. Twenty‐three global maternal‐health experts participated in the development process, which was informed by a systematic literature search on bundle definitions, designs, and implementation experiences. Over a 6‐month period, the expert panel met online and via teleconferences, culminating in a 2‐day in‐person meeting.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>The consultation led to the definition of two care bundles for facility implementation. The “first response to <jats:styled-content style="fixed-case">PPH</jats:styled-content> bundle” comprises uterotonics, isotonic crystalloids, tranexamic acid, and uterine massage. The “response to refractory <jats:styled-content style="fixed-case">PPH</jats:styled-content> bundle” comprises compressive measures (aortic or bimanual uterine compression), the non‐pneumatic antishock garment, and intrauterine balloon tamponade (<jats:styled-content style="fixed-case">IBT</jats:styled-content>). Advocacy, training, teamwork, communication, and use of best clinical practices were defined as <jats:styled-content style="fixed-case">PPH</jats:styled-content> bundle supporting elements.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>For the first response bundle, further research should assess its feasibility, acceptability, and effectiveness; and identify optimal implementation strategies. For the response to refractory bundle, further research should address pending controversies, including the operational definition of refractory <jats:styled-content style="fixed-case">PPH</jats:styled-content> and effectiveness of <jats:styled-content style="fixed-case">IBT</jats:styled-content> devices.</jats:p></jats:sec>