Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Sep 9;19(1):651.
doi: 10.1186/s12913-019-4377-6.

Bottom-up development of national obstetric guidelines in middle-income country Suriname

Kim J C Verschueren  1 , Lachmi R Kodan  2   3   4 , Tom K Brinkman  5 , Raez R Paidin  3   5   6 , Sheran S Henar  5   6 , Humphrey H H Kanhai  3   6   7 , Joyce L Browne  4 , Marcus J Rijken  2   4 , Kitty W M Bloemenkamp  2
Affiliations

Bottom-up development of national obstetric guidelines in middle-income country Suriname

Kim J C Verschueren et al. BMC Health Serv Res. .

Abstract

Background: Obstetric guidelines are useful to improve the quality of care. Availability of international guidelines has rapidly increased, however the contextualization to enhance feasibility of implementation in health facilities in low and middle-income settings has only been described in literature in a few instances. This study describes the approach and lessons learned from the 'bottom-up' development process of context-tailored national obstetric guidelines in middle-income country Suriname.

Methods: Local obstetric health care providers initiated the guideline development process in Suriname in August 2016 for two common obstetric conditions: hypertensive disorders of pregnancy (HDP) and post partum haemorrhage (PPH).

Results: The process consisted of six steps: (1) determination of how and why women died, (2) interviews and observations of local clinical practice, (3) review of international guidelines, (4) development of a primary set of guidelines, (5) initiation of a national discussion on the guidelines content and (6) establishment of the final guidelines based on consensus. Maternal enquiry of HDP- and PPH-related maternal deaths revealed substandard care in 90 and 95% of cases, respectively. An assessment of the management through interviews and labour observations identified gaps in quality of the provided care and large discrepancies in the management of HDP and PPH between the hospitals. International recommendations were considered unfeasible and were inconsistent when compared to each other. Local health care providers and stakeholders convened to create national context-tailored guidelines based on adapted international recommendations. The guidelines were developed within four months and locally implemented.

Conclusion: Development of national context-tailored guidelines is achievable in a middle-income country when using a 'bottom-up' approach that involves all obstetric health care providers and stakeholders in the earliest phase. We hope the descriptive process of guideline development is helpful for other countries in need of nationwide guidelines.

Keywords: Clinical guidelines; Contextually-tailored guidelines; Hypertensive disorders of pregnancy; Locally adapted guidelines; Middle-income country; Post partum hemorrhage; Suriname.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Obstetric guideline development strategy in Suriname in six steps
Fig. 2
Fig. 2
Example of revelations during clinical labor observations
See this image and copyright information in PMC

References

    1. Souza J, Tunçalp Ö, Vogel J, et al. Obstetric transition: the pathway towards ending preventable maternal deaths. BJOG. 2014;121:1–4. doi: 10.1111/1471-0528.12735. - DOI - PubMed
    1. Miller S, Abalos E, Chamillard M, et al. Beyond too little, too late and too much, too soon: a pathway towards evidence-based, respectful maternity care worldwide. Lancet. 2016;388(10056):2176–2192. doi: 10.1016/S0140-6736(16)31472-6. - DOI - PubMed
    1. Imamura M, Kanguru L, Penfold S, et al. A systematic review of implementation strategies to deliver guidelines on obstetric care practice in low- and middle-income countries. Int J Gynaecol Obstet. 2017;136(1):19–28. doi: 10.1002/ijgo.12005. - DOI - PubMed
    1. Stokes T, Shaw EJ, Camosso-Stefinovic J, Imamura M, Kanguru L, Hussein J. Barriers and enablers to guideline implementation strategies to improve obstetric care practice in low- and middle-income countries: a systematic review of qualitative evidence. Implement Sci. 2016;11(1):144. doi: 10.1186/s13012-016-0508-1. - DOI - PMC - PubMed
    1. Braddick L, Tuckey V, Abbas Z, et al. A mixed-methods study of barriers and facilitators to the implementation of postpartum hemorrhage guidelines in Uganda. Int J Gynecol Obstet. 2016;132(1):89–93. doi: 10.1016/j.ijgo.2015.06.047. - DOI - PubMed