In a study to be presented on February 16 between 8 a.m., and 10 a.m. PST, at the Society for Maternal-Fetal Medicine’s annual meeting, The Pregnancy Meeting ™, in San Francisco, researchers will report findings that suggest comprehensive maternal hemorrhage protocols reduce utilization of blood products and improve patient safety.
A study performed at Dignity Health, the fifth largest health care system in the United States with 31 obstetrical units, showed that the implementation of a standardized comprehensive maternal hemorrhage (CHP) protocol directed towards prevention and treatment of maternal hemorrhage significantly reduced blood product utilization and resulted in a 45% reduction in puerperal hysterectomy.
“The study shows that by following a standardized approach and having a dedicated hemorrhage cart allowing immediate availability of all the commonly used items in the event of a maternal hemorrhage, we are able to significantly reduce the amount of blood products needed as well reduce the severity of maternal hemorrhaging,” said Dr. Larry Shields, director of Maternal-Fetal Medicine at Marian Regional Medical Center in Santa Maria, Calif. “The study was conducted at hospitals with small and large obstetrical units as well as those local in major cities and in rural hospitals.”
There were 20,890 deliveries involved in the study and it produced significant percentages in blood product savings. By following the protocol there was a reduction of 22.4 percent in the number of red blood cells units, 31.4 platelets units, and a 58.1 percent reduction in the need for cryoprecipitate. The number of patients who required four or more units of blood was reduced by 88 percent.
There were four protocol stages designed to respond to varying degrees of blood loss for patients and one element of comprehensive maternal hemorrhage is the doctor needs to be on site beginning at stage 2. The stages are the following: Stage 1: bleeding greater than expected; Stage 2: bleeding not responding to conservative measures; Stage 3: blood loss in excess of 1500mL; and Stage 4: higher level of postpartum care monitoring.
“The study clearly shows that compliance leads to four major findings,” said Shields. “Less blood is needed, there is less morbidity, less hysterectomies and fewer patients needs large amounts of blood.” Shields went on to say, “Unfortunately, maternal hemorrhage is a common problem and this is clearly a relatively simple and effective way to improve maternal safety.”
Abstract 84: Comprehensive maternal hemorrhage protocols reduce utilization of blood products and improve patient safety.
Objective: To improve patient safety and address a source of major morbidity, we initiated a comprehensive maternal hemorrhage (CHP) protocol within a large health care system with 31 different delivery units with >60,000 system-wide annual births. The objective of this study was to determine if the CHP reduced the severity of obstetrical hemorrhage.
Study Design: Patients were assigned to one of four protocol stages based on the degree of blood loss: Stage 0: normal ante/postpartum assessment; Stage 1: bleeding greater than expected for vaginal delivery (500mL) or C-section (1000mL); Stage 2: bleeding not responding to conservative measures, and required physician presence, and Stage 3: blood loss in excess of 1500mL. Interventions and transfusion recommendations were specific to the patient’s stage of blood loss. Two time periods were compared: a 2-month baseline, and a second 2- month assessment 6 months after system-wide implementation of the CHP. A dedicated perinatal nurse specialist at each facility prospectively collected outcomes data.
Results: There were 20,890 deliveries during the two study periods. Relative to baseline, there was a significant reduction in blood product utilization (p = 0.04), pRBCs 22.4%, platelets 31.4%, FFP 43.2% and cryoprecipitate 58.1%. The number of patients that required ≥ 4 units of pRBCs was reduced by 88%. There was a concomitant 50% reduction in the number of patient that required puerperal hysterectomy (p = 0.01).
Conclusion: Utilization of a CHP in a large health care system significantly reduced the number of blood products despite the fact that the protocol prescribed early transfusion. Further, there was a reduction in the severity of maternal hemorrhage, and the rate of puerperal hysterectomy. These findings suggest that protocol interventions reduced the need for aggressive surgical treatment and reduced maternal morbidity. These data support the implementation of systematic treatment protocols directed towards prevention and treatment of maternal hemorrhage.
Larry Shields (1), Benda Chagolla (1), Janet Fulton (1), Barbara Pelletreau (1); Dignity Health, Patient Safety and Quality, San Francisco, CAThe Society for Maternal-Fetal Medicine (est. 1977) is a non-profit membership group for obstetricians/gynecologists who have additional formal education and training in maternal-fetal medicine. The society is devoted to reducing high-risk pregnancy complications by providing continuing education to its 2,000 members on the latest pregnancy assessment and treatment methods. It also serves as an advocate for improving public policy, and expanding research funding and opportunities for maternal-fetal medicine. The group hosts an annual scientific meeting in which new ideas and research in the area of maternal-fetal medicine are unveiled and discussed.
Society for Maternal-Fetal Medicine