Items included for the second-round consult_
| First level | Second level | Three level | Agreement (%) | Scoring of importance | ||
|---|---|---|---|---|---|---|
| M | SD | CV | ||||
| I-1 Prevention Strategies | II-2 AMTSL | Late cord clamping | 50.00 | 4.07 | 1.21 | 0.30 |
| CCT | 42.86 | 4.00 | 1.11 | 0.28 | ||
| I-2 Assessment Strategies | II-3 ABC Assessment | Airway assessment | 50.00 | 4.21 | 0.89 | 0.21 |
| Breathing assessment | 50.00 | 4.29 | 0.83 | 0.19 | ||
| II-4 Blood loss assessment | Assessing blood amount: calculate the percentage of blood loss when over 500 mL | 42.86 | 4.00 | 1.11 | 0.28 | |
| I-3 Intervention Strategies | II-7 Mild PPH (blood loss 500–1000 mL) | Fluid management: choose #16 or larger needles | 92.86 | 4.93 | 0.27 | 0.06 |
| Airway management: assess the breath sound and apply oxygen therapy for 6–10 L/min | 64.29 | 4.57 | 0.65 | 0.14 | ||
| Continuous assessment: electrocardiogram monitor is applied | 85.71 | 4.86 | 0.36 | 0.07 | ||
| Uterine atony: uterine massage | 64.29 | 4.50 | 0.76 | 0.17 | ||
| Birth canal injury: check for hematoma, cut it for drainage, suture or compress for hemostasis | 71.43 | 4.71 | 0.47 | 0.10 | ||
| Observe for signs of placenta abruption, and palpate the uterus fundus to assess contraction | 42.86 | 4.07 | 1.14 | 0.28 | ||
| CCT is performed for vaginal births once the placenta has been retaining for 30 min | 64.29 | 4.50 | 0.76 | 0.17 | ||
| Apply ultrasonography if available | 50.00 | 4.36 | 0.75 | 0.17 | ||
| II-8 Moderate PPH (blood loss 1000–2000 mL) | Airway management: assess the breath sound and apply oxygen therapy for 10–15 L/min | 71.43 | 4.64 | 0.63 | 0.14 | |
| Establish the second venous access | 92.86 | 4.93 | 0.27 | 0.06 | ||
| Adjust the infusion rate to the maximum and apply pressure to the fluid bag if necessary | 85.71 | 4.86 | 0.36 | 0.07 | ||
| Body position management: change into supine or Trendelenburg’s position | 64.29 | 4.64 | 0.50 | 0.11 | ||
| Temperature management: use warm fluid or heating device, and keep fluid temperature around 40℃ | 64.29 | 4.64 | 0.50 | 0.11 | ||
| Vital signs assessment: assess temperature every 15 min | 42.86 | 3.86 | 1.35 | 0.35 | ||
| Urine assessment: every 15 min after catheterization | 85.71 | 4.64 | 0.93 | 0.20 | ||
| Uterine atony: apply hemostatic drugs if uterotonics fails or trauma exists | 42.86 | 4.14 | 0.77 | 0.19 | ||
| Uterine atony: abdominal aortic compression | 42.86 | 4.29 | 0.73 | 0.17 | ||
| II-10 Nursing care after rescue | Hemodynamic changes: observe for 2 hours in the delivery room before transferring | 92.86 | 4.93 | 0.27 | 0.06 | |
| Hemodynamic changes: observe for vital signs, uterine contraction and loss of blood every 4 hours in the ward for the first 24 hours | 92.86 | 4.93 | 0.27 | 0.06 | ||
| I-5 Health Education after PPH | II-13 Health education for puerpera and family | Prevention of complications: anemia | 64.29 | 4.64 | 0.50 | 0.11 |
| Prevention of complications: Sheehan syndrome | 50.00 | 4.43 | 0.65 | 0.15 | ||
| Breast feeding instructions | 64.29 | 4.57 | 0.65 | 0.14 | ||
| Psychological instructions | 64.29 | 4.50 | 0.76 | 0.17 | ||
Basis of judgment and quantification of influence levels_
| Basis of judgment | Influence level | ||
|---|---|---|---|
| High | Moderate | Low | |
| Theoretical analysis | 0.3 | 0.2 | 0.1 |
| Empirical evidence | 0.5 | 0.4 | 0.3 |
| Peer communication | 0.1 | 0.1 | 0.1 |
| Intuition | 0.1 | 0.1 | 0.1 |
| Total | 1.0 | 0.8 | 0.6 |
Self-evaluation of the basis of judgment_
| Basis of judgment | Influence level | ||
|---|---|---|---|
| High | Moderate | Low | |
| Theoretical analysis | 13 | 1 | 0 |
| Empirical evidence | 13 | 1 | 0 |
| Peer communication | 7 | 6 | 1 |
| Intuition | 4 | 3 | 7 |
Demographic characters of the expert panel (n = 14)_
| Demographics | Number of experts | Percentage (%) |
|---|---|---|
| Gender | ||
| Male | 1 | 7.14 |
| Female | 13 | 92.86 |
| Age (years) | ||
| 30–39 | 6 | 42.86 |
| 40–49 | 3 | 21.43 |
| ≥50 | 5 | 35.71 |
| Title | ||
| Lecturer* | 7 | 50.00 |
| Associate professor* | 3 | 21.43 |
| Professor* | 4 | 28.57 |
| Academic degree | ||
| Bachelor | 9 | 64.29 |
| Master | 4 | 28.57 |
| PhD | 1 | 7.14 |
| Profession | ||
| Medicine | 4 | 28.57 |
| Nursing | 10 | 71.43 |
| Working experience (years) | ||
| 10–19 | 6 | 42.86 |
| 20–29 | 4 | 28.57 |
| ≥30 | 4 | 28.57 |