Institution of a Comprehensive Postpartum Hemorrhage Bundle at a Large Academic Center does not Immediately Reduce Maternal Morbidity

Abstract

Objective Obstetric hemorrhage is a leading cause of morbidity and mortality. We sought to assess whether institution of a postpartum hemorrhage (PPH) bundle could improve maternal morbidity in our population.

Study Design Preintervention data (PRE) was collected on all deliveries at Hospital of the University of Pennsylvania between October 15, 2013 and December 15, 2013. A two-pronged, multidisciplinary educational and procedural intervention related to PPH was instituted from March 2015 to June 2015. Postintervention data (POST) was collected on all deliveries from October 20, 2015 to December 20, 2015.

Results Note that 592 of 626 (95%) PRE and 583 of 613 (95%) POST deliveries were included. The rates of PPH by estimated blood loss (EBL) ≥ 1,000 mL and by 3 g hemoglobin drop were not significantly different from PRE to POST (9.0% versus 12.2%, p = 0.07 and 10.5% versus 13.5%, p = 0.10, respectively). There was no significant change in transfusion rate (3.4% versus 5.1%, p = 0.13). Use of uterotonics was reduced from 9.8 to 6.3% from PRE to POST (p = 0.03).

Conclusion While institution of a PPH bundle is designed to improve the morbidity of PPH, our data demonstrate that it cannot be expected to do so within 6 months of implementation. Further studies will need to assess the long-term effects of such a resource-intensive protocol, including perceptions of improved safety by all providers, nurses, and staff.

Keywords

postpartum hemorrhage - safety bundle - maternal morbidity - blood transfusion

Note

This data was presented at District III ACOG Junior Fellow Day in October 2016 as well as at the ACOG Annual Meeting in May 2017.

• References

• 1 World Health Organization Maternal Mortality in 2000: Estimates Developed by WHO, UNICEF, and UNFPA. World Health Organization, Geneva; 2004
• 2 AbouZahr C. Global burden of maternal death and disability. Br Med Bull 2003; 67: 1-11
• 3 DʼAlton ME, Main EK, Menard MK, Levy BS. The National Partnership for Maternal Safety. Obstet Gynecol 2014; 123 (05) 973-977
• 4 Kacmar RM, Mhyre JM, Scavone BM, Fuller AJ, Toledo P. The use of postpartum hemorrhage protocols in United States academic obstetric anesthesia units. Anesth Analg 2014; 119 (04) 906-910
• 5 Main EK, Goffman D, Scavone BM. , et al; National Partnership for Maternal Safety; Council on Patient Safety in Women's Health Care. National Partnership for Maternal Safety: consensus bundle on obstetric hemorrhage. Obstet Gynecol 2015; 126 (01) 155-162
• 6 Hamm RF, Wang EY, Bastek JA, Srinivas SK. Assessing reVITALize: should the definition of postpartum hemorrhage differ by mode of delivery?. Am J Perinatol 2017; 34 (05) 503-507
• 7 Shields LE, Smalarz K, Reffigee L, Mugg S, Burdumy TJ, Propst M. Comprehensive maternal hemorrhage protocols improve patient safety and reduce utilization of blood products. Am J Obstet Gynecol 2011; 205 (04) 368.e1-368.e8