Walker Dilys, Shin Linda, Santos Nicole, Butrick Elizabeth, Durocher Jill, Miller Suellen, Amsalu Ribka, Wanyoro Anthony
Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, California, USA.
Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, USA.
BMJ Public Health. 2024 May 30;2(1):e000113. doi: 10.1136/bmjph-2023-000113. eCollection 2024 Jun.
Postpartum haemorrhage (PPH) remains the leading cause of maternal mortality and morbidity globally. Innovative PPH management tools have emerged using suction and sponge tamponade but currently lack substantial evidence. Broader understanding and collaborative research prioritisation are needed, especially in low-income and middle-income countries (LMICs), where the burden of PPH-related mortality is highest. We aimed to describe the current state of evidence and to solicit stakeholder input to identify research priorities related to emerging tools for PPH management.
We used a four-phase modified Delphi approach to identify research priorities for emerging suction and sponge tools. In phase 1, we conducted a literature review and key informant interviews (KIIs) with 19 stakeholders. In phase 2, we distributed an online survey, receiving 66 responses. In phase 3, we virtually convened an expert panel of stakeholders (n=24) and a separate midwife-only focus group to discuss preliminary results and draft research questions. In phase 4, we surveyed our expert panel (n=37) for prioritisation of research questions. Surveys were disseminated via Research Electronic Data Capture while KIIs and the expert convening were held virtually.
Participants included clinicians, researchers, policy-makers, funders and tool developers from high-income and LMIC settings. The prioritisation process narrowed our focus from six tools to four, all of which were top-ranked priorities in phase 4. Stakeholders emphasised efficacy research in comprehensive emergency obstetric and newborn care facilities. Stakeholders stressed the importance of understanding adverse event risks. The urgency in conducting research on cost, provider ease of use and acceptability and patient experience differed between individuals from high-income versus LMIC settings.
All four tools prioritised in this process have the potential to improve PPH management in LMICs. A coordinated research agenda is necessary to confirm safety and efficacy and to determine which tools are most appropriate for specific LMIC settings.
产后出血（PPH）仍是全球孕产妇死亡和发病的主要原因。利用吸引和海绵填塞的创新型产后出血管理工具已经出现，但目前缺乏充分的证据。需要更广泛的理解和协作性研究优先级确定，尤其是在低收入和中等收入国家（LMICs），这些国家与产后出血相关的死亡率负担最高。我们旨在描述当前的证据状况，并征求利益相关者的意见，以确定与新兴产后出血管理工具相关的研究优先级。
我们采用了四阶段的改良德尔菲法来确定新兴吸引和海绵工具的研究优先级。在第一阶段，我们进行了文献综述，并对19名利益相关者进行了关键信息访谈（KIIs）。在第二阶段，我们开展了一项在线调查，收到了66份回复。在第三阶段，我们虚拟召集了一个利益相关者专家小组（n = 24）和一个单独的仅由助产士组成的焦点小组，以讨论初步结果并起草研究问题。在第四阶段，我们对专家小组（n = 37）进行了调查，以确定研究问题的优先级。调查通过研究电子数据采集系统进行传播，而关键信息访谈和专家召集则以虚拟方式进行。
参与者包括来自高收入和低收入及中等收入国家背景的临床医生、研究人员、政策制定者、资助者和工具开发者。优先级确定过程将我们的重点从六种工具缩小到四种，所有这些工具在第四阶段都是排名靠前的优先事项。利益相关者强调在综合紧急产科和新生儿护理设施中进行疗效研究。利益相关者强调了解不良事件风险的重要性。高收入国家与低收入及中等收入国家背景的个人在开展成本、提供者易用性和可接受性以及患者体验研究方面的紧迫性存在差异。
在此过程中确定优先级的所有四种工具都有可能改善低收入和中等收入国家的产后出血管理。需要一个协调一致的研究议程来确认安全性和有效性，并确定哪些工具最适合特定的低收入和中等收入国家背景。
