Barriers to Early Detection in Women Experiencing a Postpartum Hemorrhage: An Integrative Review

Abstract Aim: The aim of this integrative review is to explore barriers to early detection in women experiencing postpartum hemorrhage. Background: Women in the United States are more likely to die from childbirth complications than any other women living in other developed countries. Despite advances in maternity care, postpartum hemorrhage is the cause of nearly 70,000 maternal deaths every year, comparable to one woman dying of postpartum hemorrhage blood loss every eight minutes. Most maternal deaths are avoidable, as the solutions to prevent and manage these deadly complications are well known. Risk factors, assessment tools, causes, interventions, and outcomes are well studied and have extensive evidence-based research to support. However, significant challenges, such as accurate monitoring, assessment of blood loss, early identification of risk factors, and timely recognition of postpartum hemorrhage remain. Very few studies have explored where the gap lies in patient care, as postpartum hemorrhage continues to remain the leading cause of maternal mortality and morbidity worldwide. Method: This integrative review followed Whittemore and Knafl’s five-step methodologic framework. A comprehensive search was conducted, identifying studies published between 2016 and 2023 using predetermined inclusion criteria, exclusion criteria, and search terms. Nursing databases that were searched included CINAHL, OVID Nursing Collection, Health Source Nursing, Medline Complete, and PubMed. Data was screened and all sampling decisions were made transparent, justified, displayed, and outlined in a PRISMA flowchart. The retrieved articles were then critically appraised for quality, reliability, value, and relevance to the context using the Johns Hopkins Nursing Evidence-Based Practice Appraisal Tool. A thematic analysis was utilized that revealed emergent themes and subthemes in relevance to the aim of this integrative review. Results: The thematic analysis identified six main themes that included undervaluing preventative measures, knowledge gap of detection practices, inadequate exposure, availability of resources, increasing disparities, and timely referral. Sixteen subthemes emerged and are described more in-depth among the central themes. While most studies exemplified more than one theme, no single theme was present in all ten reviewed studies. Conclusion: The evidence elaborated on in this review highlights the barriers to early detection to bring awareness, share education, and make recommendations for ways to remove these barriers to help prevent poor maternal outcomes. Improvement in maternal health will require dedicated efforts in screening, prevention, detection, education, and management, beginning in the preconception period and continuing throughout the first year postpartum. Improving the quality of care and health outcomes can be done with thorough preparation, anticipating risk factors, coordinating a healthcare team, and ensuring access to care with timely interventional procedures. Further research is needed on screening tools, training programs, and care management worldwide as healthcare is striving to improve maternal morbidity and mortality