Saving lives: Applying patient blood management to patients with high risk for postpartum hemorrhage.
Lopez-Plaza I, Klassa P, Mooney R, and Poxon A. Saving lives: Applying patient blood management to patients with high risk for postpartum hemorrhage. Anesth Analg 2018; 127(3):68.
Background: Although the incidence of obstetrical hemorrhage is on the rise nationally, scientific evidence shows that the majority of maternal deaths associated with postpartum hemorrhage (PPH) are preventable. In 2010, after a maternal death due to PPH, our institution developed a collaborative team approach to treat obstetrical hemorrhage including the development/utilization of a massive transfusion protocol. Our initiatives also lead to more proactive interventions including identifying patients at high risk for bleeding prenatally (i.e. placental implantation problems) and offering balloon occlusion and embolization by Interventional Radiology during birth. Other proactive measures included completing a risk assessment for obstetrical hemorrhage upon admission to LDRP, liberal use of uterotonics, use of uterine tamponade balloon or B-Lynch procedure if needed and use of cell salvage technology. After implementation, we discovered fewer blood products were necessary to rescue patients and morbidity/mortality related to obstetrical hemorrhage decreased overall. Study design: Obstetric hemorrhage care protocol: The protocol is applied to all patients birthing at this community hospital at the time of presentation to the hospital for delivery or if bleeding is observed during the intrapartum or postpartum period. Data acquisition and analysis: Beginning with the implementation of the electronic medical record (EMR), the medical records of patients were reviewed for: maternal age, gravida/para status, gestational age, bleeding risk category assigned at time of delivery, delivery type (vaginal versus Cesarean section), medications utilized, procedural intervention and transfusions. Analysis was conducted comparing the first 6 months of data, beginning with the start of EMR (November 2014) to April 2016 and expressed in percentage of deliveries. Results: A total of 1930 women were delivered in this program during the study period since implementation of the massive transfusion protocol, EMR and the proactive approach in the identification of obstetrical patients with bleeding risks. The attached table shows the results as described under study design. Conclusion: By applying a patient blood management concept, the risks associated with obstetrical bleeding were reduced including the need for blood transfusions, admissions to ICU for patients with PPH with 100% successful maternal/infant outcomes.