Dame Tina Lavender

Is accurate and reliable blood loss estimation the 'crucial step' in early detection of postpartum haemorrhage: an integrative review of the literature

BackgroundPostpartum haemorrhage (PPH) is the leading cause of maternal mortality in low-income countries and severe maternal morbidity in many high-income countries. Poor outcomes following PPH are often attributed to delays in the recognition and treatment of PPH. Experts have suggested that improving the accuracy and reliability of blood loss estimation is the crucial step in preventing death and morbidity from PPH. However, there is little guidance on how this can be achieved. The aim of this integrative review was to evaluate the various methods of assessing maternal blood loss during childbirth.MethodsA systematic, integrative review of published research studies was conducted. All types of studies were included if they developed, tested, or aimed to improve methods and skills in quantifying blood loss during childbirth, or explored experiences of those involved in the process.ResultsThirty-six studies were included that evaluated the accuracy of visual estimation; tested methods to improve skills in measurement; examined their effect on PPH diagnosis and treatment, and / or explored additional factors associated with blood loss evaluation. The review found that health professionals were highly inaccurate at estimating blood loss as a volume. Training resulted in short term improvements in skills but these were not retained and did not improve clinical outcomes. Multi-faceted interventions changed some clinical practices but did not reduce the incidence of severe PPH or the timing of responses to excessive bleeding. Blood collection bags improved the accuracy of estimation but did not prevent delays or progression to severe PPH. Practitioners commonly used the nature and speed of blood flow, and the condition of the woman to indicate that the blood loss was abnormal.ConclusionsEarly diagnosis of PPH should improve maternal outcomes, but there is little evidence that this can be achieved through improving the accuracy of blood loss volume measurements. The diagnosis may rely on factors other than volume, such as speed of blood flow and nature of loss. A change in direction of future research is required to explore these in more detail.

A realist review of the partograph: when and how does it work for labour monitoring?

BackgroundThe partograph (or partogram) is recommended by the World Health Organisation (WHO), for monitoring labour wellbeing and progress. Concerns about limitations in the way the partograph is used in the clinical context and the potential impact on its effectiveness have led to this realist systematic review of partograph use.MethodsThis review aimed to answer two key questions, 1) What is it about the partograph that works (or does not work); for whom does it work; and in what circumstances? 2) What are the essential inputs required for the partograph to work? A comprehensive search strategy encompassed key databases; including papers of varying methodologies. Papers were selected for inclusion if the focus of the paper was the partograph and related to context, mechanism or outcome. Ninety five papers were included for data synthesis. Two authors completed data extraction and synthesis.ResultsThe evidence synthesis relates the evidence to identified theories of health worker acceptability, health system support, effective referral systems, human resources and health worker competence, highlighting barriers and facilitators.ConclusionsThis first comprehensive realist synthesis of the partograph, provides the international community of maternity clinicians with a picture of potential issues and solutions related to successful labour recording and management, which is also translatable to other monitoring approaches.

Improving quality of care during labour and childbirth and in the immediate postnatal period

Quality of care during labour and childbirth and in the immediate postnatal period is important in ensuring healthy maternal and newborn survival. A narrative review of existing quality frameworks in the context of evidence-based interventions for essential care demonstrates the complexities of quality of care and the domains required to provide high quality of care. The role of the care provider is pivotal to optimum care; however, providers need appropriate training and supervision, which should include assessment of core competencies. Organisational factors such as staffing levels and resources may support or hinder the delivery of optimum care and should be observed during any monitoring. The womans perspective is central to all quality of care strategies; her opinion should be sought where possible. The importance of assessing and monitoring quality of care during such a critical period should be appreciated. A number of quality frameworks offer organisations with a foundation on which they can deliver high quality care.

Corrigendum to “Fear of birth in clinical practice: A structured review of current measurement tools” [Sexual & Reproductive Healthcare 16 (2018) 98–112]

Corrigendum to “Fear of birth in clinical practice: A structured review of current measurement tools” [Sex. Reprod. Healthcare 16 (2018) 98–112] Yana Richensa,, Debbie M. Smith, Dame Tina Lavender University College Hospital London, Elizabeth Garrett Anderson Wing, 1st Floor Antenatal Clinic, 235 Euston Road, London, United Kingdom Division of Psychology and Mental Health, The University of Manchester, United Kingdom c School of Social and Health Sciences, Leeds Trinity University, United Kingdom d Centre of Global Women’s Health, Division of Nursing Midwifery and Social Work, University of Manchester, United Kingdom