{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T15:14:08Z","timestamp":1791472448258,"version":"4.3.4"},"reference-count":72,"publisher":"BMJ","issue":"5","license":[{"start":{"date-parts":[[2024,5,8]],"date-time":"2024-05-08T00:00:00Z","timestamp":1715126400000},"content-version":"unspecified","delay-in-days":7,"URL":"https:\/\/creativecommons.org\/licenses\/by\/3.0\/igo\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2024,2,19]]},"published-print":{"date-parts":[[2024,5]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>There are no globally agreed on strategies on early detection and first response management of postpartum haemorrhage (PPH) during and after caesarean birth. Our study aimed to develop an international expert\u2019s consensus on evidence-based approaches for early detection and obstetric first response management of PPH intraoperatively and postoperatively in caesarean birth.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Systematic review and three-stage modified Delphi expert consensus.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>International.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Population<\/jats:title>\n                    <jats:p>Panel of 22 global experts in PPH with diverse backgrounds, and gender, professional and geographic balance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcome measures<\/jats:title>\n                    <jats:p>Agreement or disagreement on strategies for early detection and first response management of PPH at caesarean birth.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Experts agreed that the same PPH definition should apply to both vaginal and caesarean birth. For the intraoperative phase, the experts agreed that early detection should be accomplished via quantitative blood loss measurement, complemented by monitoring the woman\u2019s haemodynamic status; and that first response should be triggered once the woman loses at least 500 mL of blood with continued bleeding or when she exhibits clinical signs of haemodynamic instability, whichever occurs first. For the first response, experts agreed on immediate administration of uterotonics and tranexamic acid, examination to determine aetiology and rapid initiation of cause-specific responses. In the postoperative phase, the experts agreed that caesarean birth-related PPH should be detected primarily via frequently monitoring the woman\u2019s haemodynamic status and clinical signs and symptoms of internal bleeding, supplemented by cumulative blood loss assessment performed quantitatively or by visual estimation. Postoperative first response was determined to require an individualised approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>These agreed on proposed approaches could help improve the detection of PPH in the intraoperative and postoperative phases of caesarean birth and the first response management of intraoperative PPH. Determining how best to implement these strategies is a critical next step.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2023-079713","type":"journal-article","created":{"date-parts":[[2024,5,8]],"date-time":"2024-05-08T13:07:18Z","timestamp":1715173638000},"page":"e079713","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":12,"title":["Strategies for optimising early detection and obstetric first response management of postpartum haemorrhage at caesarean birth: a modified Delphi-based international expert consensus"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7889-2825","authenticated-orcid":false,"given":"Ver\u00f3nica","family":"Pingray","sequence":"first","affiliation":[{"name":"Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4925-869X","authenticated-orcid":false,"given":"Caitlin R","family":"Williams","sequence":"additional","affiliation":[{"name":"Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina"},{"name":"Department of Maternal & Child Health, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fadhlun M Alwy","family":"Al-beity","sequence":"additional","affiliation":[{"name":"Department of Obstetrics & Gynaecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania"},{"name":"Department of Global Public Health, Karolinska Institute, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edgardo","family":"Abalos","sequence":"additional","affiliation":[{"name":"Maternidad Martin, Secretar\u00eda de Salud P\u00fablica de la Municipalidad de Rosario, Rosario, Santa Fe, Argentina"},{"name":"Centro de Estudios de Estado y Sociedad, Buenos Aires, Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabaratnam","family":"Arulkumaran","sequence":"additional","affiliation":[{"name":"Department of Obstetrics & Gynaecology, St George\u2019s Hospital, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alejandro","family":"Blumenfeld","sequence":"additional","affiliation":[{"name":"Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina"},{"name":"Department of Public Health, Faculty of Medicine, Universidad de Buenos Aires, Buenos Aires, Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4919-4542","authenticated-orcid":false,"given":"Brendan","family":"Carvalho","sequence":"additional","affiliation":[{"name":"Stanford University School of Medicine, Stanford, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"Deneux-Tharaux","sequence":"additional","affiliation":[{"name":"Obstetrical Perinatal and Pediatric Epidemiology Research team, Centre for Research in Statistics and Epidemiology (CRESS) Universit\u00e9 Paris Cit\u00e9 INSERM, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soo","family":"Downe","sequence":"additional","affiliation":[{"name":"Research in Childbirth and Health, University of Central Lancashire, Preston, UK"},{"name":"THRIVE Centre, School of Heath and Community Studies, University of Central Lancashire, Preston, 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