title: The impact of the implementation of the postpartum haemorrhage management guidelines at the first regional perinatal centre in Southern Kazakhstan.
abstract: Postpartum haemorrhage (PPH) remains one of the most common causes of maternal morbidity and mortality. Therefore, clearly written PPH management guidelines should be used in clinical practice. The aim of this study was to evaluate the effectiveness of the implementation of PPH management guidelines at the First Regional Perinatal Centre of Southern Kazakhstan (FRPC).
  
  
  
  Between 2012 and 2013 an interventional study was performed whereby the PPH management guidelines were implemented at the FRPC. All of the deliveries that were complicated by PPH 8 months before and 8 months after the intervention were analysed. Prevalence and severity of PPH, and the change in prevention, diagnostics and management of PPH was evaluated and statistical analysis using the SPSS 22.0 was performed.
  
  
  
  There were in total 5404 and 5956 deliveries in the pre- and post-intervention periods, respectively. The rates of PPH and severe PPH decreased from 1.17 to 1.02 % (p = 0.94) and from 0.24 to 0.22 % (p = 0.94), respectively. Blood loss on average increased from 1055 to 1170 ml in the post-intervention period. The pharmacological treatment of postpartum haemorrhage with uterotonics was administered most frequently during both periods. After the implementation of the guidelines, the number of transfused units of packed red blood cells decreased from 4.76 to 2.48 units/case. In addition, the amount of transfused fresh frozen plasma decreased by 20 %. The number of conservative interventions and conservative operations increased from 7.9 to 52.7 % and from 3.9 to 48.6 %, respectively. The number of hysterectomies decreased from 23.7 % in pre-intervention to 8.1 % in the post-intervention period.
  
  
  
  The implementation of the PPH management guidelines had a positive effect on PPH prevention, diagnostics and management. It led to a more conservative aproach to the treatment of PPH. Therefore, clearly written PPH management guidelines, adapted for a particular hospital, should be developed and used in clinical practice.
authors.affiliation: Lithuanian University of Health Sciences, Eiveniu str. 2, 50167, Kaunas, Lithuania.
authors.forename: Ruta J
authors.initials: RJ
authors.lastname: Nadisauskiene
authors.affiliation: Lithuanian University of Health Sciences, Eiveniu str. 2, 50167, Kaunas, Lithuania.
authors.forename: Paulius
authors.initials: P
authors.lastname: Dobozinskas
authors.affiliation: Lithuanian University of Health Sciences, Eiveniu str. 2, 50167, Kaunas, Lithuania. jusbra@hotmail.com.
authors.forename: Justina
authors.initials: J
authors.lastname: Kacerauskiene
authors.affiliation: Lithuanian University of Health Sciences, Eiveniu str. 2, 50167, Kaunas, Lithuania.
authors.forename: Mindaugas
authors.initials: M
authors.lastname: Kliucinskas
authors.affiliation: Health Department of the Southern Kazakhstan Region, Zeltoksan str. 20 "A", Shymkent, 160012, South Kazakhstan Region, Republic of Kazakhstan.
authors.forename: Ismailov
authors.initials: I
authors.lastname: Zhumagali
authors.affiliation: First Regional Perinatal Centre in Southern Kazakhstan, G. Iliaeva str. 142A, Enbekshinskii raion, Shymkent, 160011, South Kazakhstan Region, Republic of Kazakhstan.
authors.forename: Madina
authors.initials: M
authors.lastname: Kokenova
authors.affiliation: First Regional Perinatal Centre in Southern Kazakhstan, G. Iliaeva str. 142A, Enbekshinskii raion, Shymkent, 160011, South Kazakhstan Region, Republic of Kazakhstan.
authors.forename: Jesengeldy
authors.initials: J
authors.lastname: Bekeshov
authors.affiliation: Health Department of the Southern Kazakhstan Region, Zeltoksan str. 20 "A", Shymkent, 160012, South Kazakhstan Region, Republic of Kazakhstan.
authors.forename: Saltanat
authors.initials: S
authors.lastname: Dzabagijeva
authors.affiliation: Health Department of the Southern Kazakhstan Region, Zeltoksan str. 20 "A", Shymkent, 160012, South Kazakhstan Region, Republic of Kazakhstan.
authors.forename: Aigul
authors.initials: A
authors.lastname: Sapargalijeva
authors.affiliation: Health Department of the Southern Kazakhstan Region, Zeltoksan str. 20 "A", Shymkent, 160012, South Kazakhstan Region, Republic of Kazakhstan.
authors.forename: Inna
authors.initials: I
authors.lastname: Glazebnaja
authors.affiliation: First Regional Perinatal Centre in Southern Kazakhstan, G. Iliaeva str. 142A, Enbekshinskii raion, Shymkent, 160011, South Kazakhstan Region, Republic of Kazakhstan.
authors.forename: Gulmyra
authors.initials: G
authors.lastname: Konyrbajeva
authors.affiliation: First Regional Perinatal Centre in Southern Kazakhstan, G. Iliaeva str. 142A, Enbekshinskii raion, Shymkent, 160011, South Kazakhstan Region, Republic of Kazakhstan.
authors.forename: Zijas
authors.initials: Z
authors.lastname: Uteshova
authors.affiliation: First Regional Perinatal Centre in Southern Kazakhstan, G. Iliaeva str. 142A, Enbekshinskii raion, Shymkent, 160011, South Kazakhstan Region, Republic of Kazakhstan.
authors.forename: Aina
authors.initials: A
authors.lastname: Tasbulatova
mesh_terms: D001803:Blood Transfusion / Q000379:methods / Q000639:trends; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006284:Health Plan Implementation / Q000706:statistics & numerical data*; D006801:Humans; D007044:Hysterectomy / Q000639:trends; D007623:Kazakhstan / Q000453:epidemiology; D010120:Oxytocics / Q000627:therapeutic use; D018743:Perinatal Care / Q000379:methods / Q000592:standards / Q000639:trends*; D006473:Postpartum Hemorrhage / Q000453:epidemiology* / Q000628:therapy; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D015995:Prevalence
chemical_list: D010120:Oxytocics
keywords: Guidelines; Management; Outcomes; Postpartum haemorrhage