Table 4 Obstacles according to professionals (web-based survey results: quantitative study)

The national guideline lacks a flowchart to use in acute situations

55

54

69

48

39

My local protocol does not say you should establish a policy for the delivery of a high-risk patient^a

39

33

38

48

43

My local protocol does not say you should consider a manual placenta removal at 500 ml blood loss^a

39

34

36

59

30

I have to find out myself that there is an update of the guideline

35

29

36

34

50

The guideline is difficult to obtain in our delivery room

27

27

23

30

34

My local protocol does not say you should weigh blood loss for every high-risk patient^a

26

17

27

27

25

You cannot use the national PPH-guideline in acute situations

25

24

29

25

16

Measuring the urine output is low on my list of priorities

57

44

65

66

55

I don’t have enough skills to perform surgical interventions (B-lynch etc.)

50

30

77

NA

NA

Professionals are not aware that warm saline infusion is beneficial

50

35

63

61

50

The recommendations for >1000 ml blood loss are less important when a patient lost 1000 instead of 1500 ml

25

23

30

31

14

We do not weigh the blood loss for every high-risk patient when it is estimated as little

36

24

49

44

32

I don’t have enough knowledge to perform surgical interventions (B-lynch etc.)

27

7

53

NA

NA

I don’t have enough knowledge about bimanual compression

26

11

33

56

NA

Lack of experience of the team members with the use of warm saline infusion

50

45

53

56

48

Working with inexperienced obstetricians (in training) is an obstacle

30

20

36

34

39

There is a need for more skills and drills

53

42

67

57

50

In my hospital it is not possible to give a patient warm saline infusion

50

40

49

59

68

Complication discussions are not multidisciplinary

44

31

65

43

34

Time is an obstacle for organising skills and drills

38

36

51

31

27

Not every delivery room has material to measure urine output

36

18

33

57

61

The multidisciplinary arrangements are not tight enough

33

2

42

30

27

Organising debriefings is too time consuming

32

29

39

33

23

Complication discussions are not organised on a regular basis

30

17

48

31

25

Facilitators

A flowchart about PPH in the delivery room would improve care

63

50

73

68

58

A checklist about PPH in the delivery room would improve care

57

51

56

63

60

There is a need for more skills and drills

53

42

67

57

50

A second gynaecologist on duty for only emergencies would help me to quickly consult an extra gynaecologist

30

26

34

NA

NA