Please use this identifier to cite or link to this item:
Scopus Web of Science® Altmetric
Type: Journal article
Title: From postpartum haemorrhage guideline to local protocol: a study of protocol quality
Author: Woiski, M.
van Vugt, H.
Dijkman, A.
Grol, R.
Marcus, A.
Middeldorp, J.
Mol, B.
Mols, F.
Oudijk, M.
Porath, M.
Scheepers, H.
Hermens, R.
Citation: Maternal and Child Health Journal, 2016; 20(10):2160-2168
Publisher: Springer
Issue Date: 2016
ISSN: 1092-7875
Statement of
Mallory D. Woiski, Helena C. van Vugt, Anneke Dijkman, Richard P. Grol, Abraham Marcus, Johanna M. Middeldorp, Ben W. Mol, Femke Mols, Martijn A. Oudijk, Martina Porath, Hubertina J. Scheepers, Rosella P. Hermens
Abstract: Objective: Postpartum hemorrhage (PPH) has a continuously rising incidence worldwide, suggesting suboptimal care. An important step in optimizing care is the translation of evidence-based guidelines into comprehensive hospital protocols. However, knowledge about the quality of these protocols is lacking. The objective of this study was to evaluate the quality of PPH-protocols on structure and content in the Netherlands. Methods: We performed an observational multicenter study. Eighteen PPH-protocols from 3 University Hospitals (UH), 8 Teaching Hospitals (TH) and 7 Non-Teaching hospitals (NTH) throughout the Netherlands were acquired. The structure of the PPH-protocols was assessed using the Appraisal of Guidelines for Research and Evaluation (AGREE-II) Instrument. The content was appraised using previously developed quality indicators, based on international guidelines and Advance-Trauma-Life-Support (ATLS)-based course instructions. Results: The quality of the protocols for postpartum hemorrhage for both structure and content varied widely between different hospitals, but all of them showed room for improvement. The protocols scored mainly below average on the different items of the AGREE-II instrument (8 of the 10 items scored <4 on a 1-7 scale). Regarding the content, adoption of guideline recommendations in protocols was 46 %. In addition, a timely indication of 'when to perform' a recommendation was lacking in three-fourths of the items. Conclusion: This study shows that the quality of the PPH-protocols for both structure and content in the Netherlands is suboptimal. This makes adherence to the guideline and ATLS-based course instructions difficult.
Keywords: Health care quality access and evaluation; guideline adherence; postpartum hemorrhage; clinical protocols
Rights: © The Author(s) 2016. This article is published with open access at Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
DOI: 10.1007/s10995-016-2050-9
Appears in Collections:Aurora harvest 3
Obstetrics and Gynaecology publications

Files in This Item:
File Description SizeFormat 
hdl_116250.pdfPublished Version328.45 kBAdobe PDFView/Open

Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.