National Partnership for Maternal Safety Consensus Bundle on Obstetric Hemorrhage

Abstract

Hemorrhage is the most frequent cause of severe maternal morbidity and preventable maternal mortality and therefore is an ideal topic for the initial national maternity patient safety bundle. These safety bundles outline critical clinical practices that should be implemented in every maternity unit. They are developed by multidisciplinary work groups of the National Partnership for Maternal Safety under the guidance of the Council on Patient Safety in Women's Health Care. The safety bundle is organized into 4 domains: Readiness, Recognition and Prevention, Response, and Reporting and Systems Learning. Although the bundle components may be adapted to meet the resources available in individual facilities, standardization within an institution is strongly encouraged. References contain sample resources and "Potential Best Practices" to assist with implementation.

Patterns and predictors of severe postpartum anemia after Cesarean section

“…Due to the observational nature of our study design, we could not examine factors that influence physicians' decision to transfuse or screen for anemia before or after Cesarean section. Although obstetric agencies are focusing attention on initiatives to reduce major maternal morbidity, future studies are needed to determine whether improvements in anemia screening and the use of non–RBC‐based therapies can improve patient‐centric outcomes, including debilitating maternal quality of life disorders, such as fatigue and depression.…”

Don’t Dismiss the Dangerous: Obstetric Hemorrhage

“…The rate of obstetric hemorrhage appears to be increasing in the United States, United Kingdom, and Australia . Major efforts are now underway by the American Congress of Obstetricians and Gynecologists and state and national collaboratives to craft a more structured approach to prevention and treatment of hemorrhage …”

“…Concealed bleeding also can occur after a vaginal birth from a cervical laceration that extends beyond the vagina into the peritoneal cavity or from a vaginal wall injury with arterial bleeding, thereby creating a large sidewall hematoma. It is common for providers to miss or ignore signs of obstetric hemorrhage (referred to as denial and delay), especially for concealed hemorrhages . In such cases, hypotension may be attributed to “the result of spinal or epidural anesthesia,” and providers may choose to wait until the spinal or epidural wears off.…”

Postpartum hemorrhage: a continuing challenge

“…The National Partnership for Maternal Safety in the US has presented an obstetric patient safety bundle (Table 2) which is recommended for every US maternity unit to have available for every delivery. 18 An additional useful resource is the California Maternal Quality Care Collaborative (CMQCC), who updated their comprehensive, web-based obstetric hemorrhage toolkit in 2015. 19 A central strategy in PPH protocols is early recognition through regular assessment of uterine tone and vital signs, prophylactic and therapeutic use of uterotonics and active management of the third stage of labor.…”