title: Postpartum haemorrhage in midwifery care in the Netherlands: validation of quality indicators for midwifery guidelines.
abstract: BACKGROUND
  Postpartum haemorrhage (PPH) is still one of the major causes of severe maternal morbidity and mortality worldwide. Currently, no guideline for PPH occurring in primary midwifery care in the Netherlands is available. A set of 25 quality indicators for prevention and management of PPH in primary care has been developed by an expert panel consisting of midwives, obstetricians, ambulance personal and representatives of the Royal Dutch College of Midwives (KNOV) and the Dutch Society of Obstetrics and Gynecology (NVOG). This study aims to assess the performance of these quality indicators as an assessment tool for midwifery care and suitability for incorporation in a professional midwifery guideline.
  
  
  METHODS
  From April 2008 to April 2010, midwives reported cases of PPH. Cases were assessed using the 25 earlier developed quality indicators. Quality criteria on applicability, feasibility, adherence to the indicator, and the indicator's potential to monitor improvement were assessed.
  
  
  RESULTS
  98 cases of PPH were reported during the study period, of which 94 were analysed. Eleven indicators were found to be applicable and feasible. Five of these indicators showed improvement potential: routine administration of uterotonics, quantifying blood loss by weighing, timely referral to secondary care in homebirth and treatment of PPH using catherisation, uterine massage and oxytocin and the use of oxygen.
  
  
  CONCLUSIONS
  Eleven out of 25 indicators were found to be suitable as an assessment tool for midwifery care of PPH and are therefore suitable for incorporation in a professional midwifery guideline. Larger studies are necessary to confirm these results.
authors.affiliation: Department of Obstetrics, Leiden University Medical Centre, K6-35, PO Box 9600, Leiden, 2300 RC, the Netherlands. m.smit.verlos@lumc.nl.
authors.forename: Marrit
authors.initials: M
authors.lastname: Smit
authors.affiliation: Department of Obstetrics, Leiden University Medical Centre, K6-35, PO Box 9600, Leiden, 2300 RC, the Netherlands. karlichan1988@gmail.com.
authors.forename: Kar-Li L
authors.initials: KL
authors.lastname: Chan
authors.affiliation: Department of Obstetrics, Leiden University Medical Centre, K6-35, PO Box 9600, Leiden, 2300 RC, the Netherlands. J.M.Middeldorp@lumc.nl.
authors.forename: Johanna M
authors.initials: JM
authors.lastname: Middeldorp
authors.affiliation: EMGO Institute for Health and Care Research Department of Medical Humanities, VU University Medical Centre, Amsterdam, the Netherlands. J.J.M.van_Roosmalen@lumc.nl.
authors.forename: Jos
authors.initials: J
authors.lastname: van Roosmalen
mesh_terms: D000328:Adult; D005260:Female; D006700:Home Childbirth; D006801:Humans; D008880:Midwifery / Q000592:standards*; D009426:Netherlands; D010043:Outcome and Process Assessment, Health Care; D010121:Oxytocin / Q000627:therapeutic use; D006473:Postpartum Hemorrhage / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011320:Primary Health Care; D019984:Quality Indicators, Health Care; D012017:Referral and Consultation; D055815:Young Adult
chemical_list: D010121:Oxytocin