Adapting and Updating a Clinical Practice Guideline for Women with Postpartum Hemorrhage at King Saud University Medical City: A Methodological Report from Saudi Arabia

Background: Postpartum hemorrhage (PPH) remains a leading contributor to maternal morbidity and mortality globally and represents a substantial cause of obstetric emergencies within tertiary care centers, including King Saud University Medical City (KSUMC). Standardizing institutional response through evidence-based clinical guidelines, protocols, algorithms, and pathways is critical to mitigating its impact. Objective: To update the KSUMC institutional evidence-based clinical practice guideline (CPG) for the management of PPH, originally adapted in 2018, using a contextualized methodology suitable for local healthcare systems. Methods: This revised CPG was developed using the KSU-Modified-ADAPTE methodology, a structured approach tailored for local adaptation of international CPGs. The CPG adaptation group conducted a systematic review of existing high-quality source CPGs, ultimately selecting the 2016 green-top CPG developed by the Royal College of Obstetricians and Gynaecologists (RCOG). Formal permission to adapt the RCOG CPG was obtained. The guideline’s methodological transparency and institutional implementability were strengthened using the RIGHT-Ad@pt and CheckUp reporting checklists, both endorsed by the EQUATOR Network. This adapted CPG is registered with the PREPARE/IPGRP international registry of CPGs. Results: Eighteen evidence-informed recommendations were adapted, covering the continuum of PPH care, from early recognition to escalation and surgical intervention. Each recommendation was contextualized to align with KSUMC’s infrastructure, emergency response protocols, policies and procedures, and available resources. Conclusion: The updated KSUMC PPH CPG provides a pragmatic, evidence-based roadmap for standardized care, reinforcing institutional preparedness and multidisciplinary response to one of the most critical obstetric emergencies.