Improving maternal health and safety through adherence to postpartum hemorrhage protocol in Latin America.

Objective: To determine provider compliance with protocols for the prevention of postpartum hemorrhage and provider characteristics associated with adherence and non-adherence.

Methods: A multicenter descriptive study was conducted involving 78 direct observations of provider-implemented protocols and 52 interviews with Peruvian maternal healthcare providers at 4 Peruvian clinical sites representing the local, regional, and national levels of care. Parturient participants planning a normal vaginal delivery were 17-49 years of age and 34-42 weeks pregnant. Primary outcomes were compared using χ2 testing, while quantitative survey data were evaluated using means, standard deviations, and Student t test or analysis of variance for statistical significance.

Results: There were 3 significant differences between the national, regional, and local levels of care: adherence to all 3 interventions (P<0.001); professional experience (P<0.04); and retention of healthcare providers (P<0.001). There were no differences in provider training (P<0.097), and the retention of experienced healthcare providers was not associated with greater adherence to protocols. There were no significant differences in parturient characteristics.

Conclusion: Individual characteristics and institutional beliefs may have more influence than experience or training on adherence to protocols for prevention of postpartum hemorrhage; addressing these biases may improve patient safety in Peru and throughout Latin America.