Conclusions
This integrative review has revealed that most studies
attempting to improve recognition and response to PPH
have focussed on improving volume estimates of blood
loss. However, it should not be assumed that because
PPH is defined as a volume, PPH diagnosis occurs as a
response to volume. The lack of qualitative research in
this area means that factors that affect decision-making
during PPH diagnosis and the usefulness of the methods
of measurement presented have not been explored. The
small amount of qualitative evidence available suggests
that the nature and speed of the blood loss as well as the
condition of the woman are important factors in the
decision-making process. It is likely that recognition of a
clinically important postpartum haemorrhage at childbirth
is a complex, dynamic, process and that estimation
of blood loss volume plays only a small part.
while a small number of strategies did achieve more
accurate and reliable estimations of blood loss in practice,
none had any significant impact on the timing of