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Due to the increasing incidence, international recommendations have been implemented, such as the D\u2011A-CH algorithm, an interdisciplinary and transnational treatment algorithm for Germany, Austria and Switzerland. This study aims to evaluate both the impact of implementing a\u00a0hemostaseology working group and adopting the internationally recognized D\u2011A-CH algorithm on the clinical management of PPH in a\u00a0university hospital.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      In this single-center retrospective observational study, patient records were reviewed from all patients treated for PPH between March 2003 and July 2021 at the University Hospital Ulm, Germany (\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u2009341). Data were divided into three groups: (I) patients treated before the implementation of a\u00a0working group for hemostaseology (\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u200940), (II) patients treated after the implementation of a\u00a0working group for hemostaseology and before the clinical application of the D\u2011A-CH-algorithm (\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u2009103) and (III) patients treated after the clinical application of the D\u2011A-CH algorithm (\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u2009198).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      After the implementation of the D\u2011A-CH-algorithm, a\u00a0significantly higher amount of fibrinogen (2.0\u2009g, interquartile range, IQR, 0.0\u20133.0\u2009g in group\u00a0III vs.\u00a00.0\u2009g, IQR 0.0\u20132.0\u2009g in group\u00a0II and 0.0\u2009g, IQR 0.0\u20130.0\u2009g in group\u00a0I ;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&lt;\u20090.0001) and tranexamic acid (1.0\u2009g, IQR 1.0\u20131.5\u2009g in group\u00a0III vs. 1.0\u2009g, IQR 0.0\u20131.0\u2009g in group\u00a0II and 0.0\u2009g,\u00a0IQR 0.0\u20130.0\u2009g in group\u00a0I;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&lt;\u20090.0001) was administered. Additionally, transfusion of allogeneic blood products (units of concentrated red cells: 2.0, IQR\u00a00.0\u20134.0 in group\u00a0III vs.\u00a03.0, IQR 2.0\u20135.0 in group\u00a0II and 3.0, IQR\u00a00.0\u20137.8 in group\u00a0I;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u20090.0036), intensive care unit (ICU) stay (3.0\u00a0days, IQR\u00a02.0\u20134.0\u00a0days in group\u00a0III vs. 3.0\u00a0days, IQR\u00a02.0\u20135.0\u00a0days in group\u00a0II and 3.0\u00a0days, IQR\u00a02.0\u20134.3\u00a0days in group\u00a0I;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u20090.0195) and hospital stay (5.0\u00a0days, IQR\u00a03.0\u20137.0\u00a0days in group\u00a0III vs.\u00a07.0\u00a0days, IQR 5.0\u20139.0\u00a0days in group\u00a0II and 7.0\u00a0days, IQR 5.0\u20139.0\u00a0days in group\u00a0I;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&lt;\u20090.0001) was significantly reduced. Implementation of a\u00a0hemostaseology working group alone was only associated with increased fibrinogen and tranexamic acid administration.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this retrospective study, application of the D\u2011A-CH algorithm was associated with improved targeted hemostatic therapy and reduced transfusion requirements as well as shorter ICU and hospital stays, whereas implementation of a\u00a0hemostaseology working group alone was only associated with increased fibrinogen and tranexamic acid administration. Due to the retrospective design of the study and inherent limitations therein, we were unable to draw a\u00a0causative effect relationship. Nonetheless, our results warrant further study.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00101-026-01727-6","type":"journal-article","created":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T08:56:34Z","timestamp":1788425794000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Management of postpartum hemorrhage at a\u00a0level\u00a01 perinatal center","Behandlung postpartaler Blutungen in einem Perinatalzentrum Level\u00a01"],"prefix":"10.1007","author":[{"given":"Sebastian","family":"Hafner","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Wepler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Mayer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Haas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bettina","family":"Jungwirth","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wolfgang","family":"Janni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beate","family":"H\u00fcner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amelie","family":"de Gregorio","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikolaus","family":"de Gregorio","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gebhard","family":"Fr\u00f6ba","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benedikt","family":"Schick","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,9,3]]},"reference":[{"issue":"6","key":"1727_CR1","doi-asserted-by":"publisher","first-page":"e323","DOI":"10.1016\/S2214-109X(14)70227-X","volume":"2","author":"L Say","year":"2014","unstructured":"Say\u00a0L, Chou\u00a0D, Gemmill\u00a0A et\u00a0al (2014) Global causes of maternal death: a WHO systematic analysis. 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Best Pract Res Clin Anaesthesiol 36:349\u2013357. https:\/\/doi.org\/10.1016\/j.bpa.2022.10.001","journal-title":"Best Pract Res Clin Anaesthesiol"}],"container-title":["Die Anaesthesiologie"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00101-026-01727-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00101-026-01727-6","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00101-026-01727-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T08:56:36Z","timestamp":1788425796000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00101-026-01727-6"}},"subtitle":["A\u00a0retrospective analysis over a\u00a0period of 18\u00a0years","Retrospektive Analyse \u00fcber einen Zeitraum von 18\u00a0Jahren"],"short-title":[],"issued":{"date-parts":[[2026,9,3]]},"references-count":31,"alternative-id":["1727"],"URL":"https:\/\/doi.org\/10.1007\/s00101-026-01727-6","relation":{},"ISSN":["2731-6858","2731-6866"],"issn-type":[{"value":"2731-6858","type":"print"},{"value":"2731-6866","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,3]]},"assertion":[{"value":"31 March 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 July 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 September 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"S.\u00a0Hafner received honoraria from CSL Behring, Marburg, Germany. M.\u00a0Wepler, B.\u00a0Mayer, D.\u00a0Haas, B.\u00a0Jungwirth, W.\u00a0Janni, B.\u00a0H\u00fcner, A.\u00a0de Gregorio, N.\u00a0de Gregorio, G.\u00a0Fr\u00f6ba and B.\u00a0Schick declare that they have no competing interests.","order":1,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study was approved by the ethics committee of the University of Ulm, Germany (AZ 50\/21). For this article no studies with human participants or animals were performed by any of the authors. All studies performed were in accordance with the ethical standards indicated in each case.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}}]}}