Skuteczność protokołów pielęgniarstwa opartego na dowodach w zarządzaniu krwotokiem poporodowym po porodzie drogami natury: prospektywna obserwacyjna ocena poprawy jakości

OBJECTIVE: To investigate the effectiveness of evidence-based intervention strategies in managing postpartum hemorrhage following vaginal delivery. METHODS: This was a prospective, observational quality-improvement evaluation conducted among 120 women who experienced postpartum hemorrhage after vaginal delivery. Two nursing strategies were compared consecutively: a conventional nursing routine and a structured evidence-based nursing protocol developed from current literature and clinical guidelines. Outcomes assessed included postpartum blood loss, coagulation indicators [prothrombin time (PT), thrombin time (TT), activated partial thromboplastin time (APTT), and fibrinogen (FIB)], adverse events, self-care ability, nursing satisfaction, emotional status [Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS)], and quality of life. RESULTS: Compared with the routine nursing phase, the evidence-based nursing phase was associated with lower bleeding volume at 0.5, 2, 12, and 24 h postpartum (P < 0.05). After 5 days of nursing care, PT, TT, and APTT were shorter, and FIB levels were higher (P < 0.05). The frequency of adverse events was lower (10.0% vs. 23.3%), while self-care ability, nursing satisfaction, and quality-of-life scores were higher. Both phases showed decreases in SAS and SDS scores, with greater improvement observed in the evidence-based phase (P < 0.05). CONCLUSION: An observational study of quality-improvement demonstrated a significant association between the implementation of a standardized evidence-based nursing protocol and reduced postpartum hemorrhage, improved coagulation profiles, lower incidence of adverse events, and improved psychosocial outcomes. These results should be validated in future randomized controlled trials.