The standardized domain scores (out of a maximum of 100), derived following evaluation with the AGREE instrument, were as follows: scope and purpose – 86.1; stakeholder involvement – 50.1; rigour of development – 76.2; clarity and presentation – 79.2, applicability – 44.4; and editorial independence – 37.5. In deriving these scores, the authors considered certain factors in order to determine the strengths and weaknesses of the guideline in the respective domains. With regard to scope and purpose, the authors collectively agreed that the objectives, the clinical questions considered and the patients who would ultimately benefit from the guidelines had been specifically described. For stakeholder involvement in the preparation of the guidelines, relevant professional groups had been involved and the end-users clearly defined. However, patients’ views had not been included, and neither had the guidelines been piloted among end-users. The authors of this appraisal agreed also that rigour of development of the guideline was satisfactory with respect to systematic searching and selection of evidence, clarity of description of the methods used for formulating recommendations and consideration of potential benefits and risks of interventions, external peer review and established procedures for updating the guideline. Clarity and presentation were rated as satisfactory given that the recommendations were clear and unambiguous, different options of management of the condition had been considered and key recommendations were easily identifiable. However, the guidelines were adjudged to be weak with respect to applicability (consideration of barriers and cost implication for implementing the recommendations) and editorial independence (lack of independence from funding body and non-declaration of conflict of interest). The latter judgement was made owing to the lack of a clear statement in the guidelines about declaration of conflict of interest by the group that developed the guidelines.
All authors agreed that the recommendations would enable health-care providers and policy-makers to introduce interventions that will help to reduce the impact of PPH. The recommendations also address dissemination and implementation steps and consider the different settings in developing countries in which women give birth – i.e. facility births and home births. The different types of health-care provider who provide assistance for women at delivery are also covered; the recommendations adopt a broad definition of a "skilled birth attendant" in order to accommodate the variable levels of skills available in developing countries.
Active management of the third stage of labour or use of any of its components by non-skilled health-care providers attending births is not recommended in the guidelines. However, no alternative recommendations for non-skilled providers are made despite the guidelines acknowledging that non-skilled providers are involved in the management of labour in under-resourced settings.