Takeaway
- The D-A-CH algorithm results in faster time to treatment of postpartum hemorrhage (PPH) but does not decrease overall blood loss.
Why this matters
- 140,000 women die annually as a result of PPH.
- Severe PPH is defined as blood loss ≥1000 mL within 24 hours of delivery.
- D-A-CH Handlungsalgorithmus Postpartale Blutung was developed in 2012 by a multidisciplinary and multinational team as a tool to standardize the treatment of PPH after vaginal delivery.
Key results
- The estimated total blood loss did not differ between the control group and the intervention group.
- The blood transfusion rate, ICU admission rate, and hemoglobin levels did not differ between groups.
- The intervention group had greater use (ORs) of:
- Medications/procedures including sulprostone: 2.42 (P=.004);
- Tranexamic acid: 6.27 (P<.001);
- Thromboelastometry: 32.37 (P=.012); and
- Bakri balloon tamponade: 7.82 (P=.004).
- Tranexamic acid was applied earlier in the intervention group (P<.001).
Study design
- Single-center retrospective case series comparing blood loss prior to initiation of algorithm and after initiation of algorithm.
- Control group (women with PPH prior to intervention; n=141) compared with intervention group (n=176).
- Primary endpoint was the estimated total postpartum blood loss.
- Funding: Individual authors received honoraria; no funding disclosed for study.
Limitations
- Small sample size.
- Single-site study.
References
References
