National Partnership for Maternal Safety: Consensus Bundle on Obstetric Hemorrhage

Main, Elliott K.; Goffman, B.M.; Kane, Lennox; Bingham, Debra; Fontaine, Patricia; Gorlin, Jed B.; Lagrew, David C.; Levy, Barbara

doi:10.1097/01.aoa.0000482622.40786.7b

Cited by 64 publications

(110 citation statements)

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“…Women from metropolitan counties may deliver at hospitals more prepared to detect and manage their anemia. For instance, many metropolitan hospitals have protocols to manage obstetric hemorrhages through the implementation of consensus bundles 41,42 . Hospitals providing obstetric care to rural women may be less prepared to manage acute obstetric emergencies, resulting in increased morbidity and greater need for transfusion.…”

Section: Discussionmentioning

confidence: 99%

Rural residency as a risk factor for severe maternal morbidity

Hansen

Slavova

O’Brien

2021

The Journal of Rural Health

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Purpose The goal of this study was to evaluate how rural/urban status and other risk factors alter women's odds of severe maternal morbidity (SMM) at delivery. Methods This study used 48,608 Kentucky resident delivery hospitalization records from 2017. We used multiple logistic regression with interaction terms to evaluate the moderating effect of rural/urban residence with other risk factors. We reported adjusted odds ratios (aORs) and 95% confidence intervals (CIs) as measures for association with the outcome of SMM at delivery. Findings The percentage of delivery hospitalizations with SMM was higher for women with rural (2.4%) versus metro (1.1%) or metro‐adjacent (1.5%) residence (p < .001). Rural status moderated the effect of anemia on SMM. The aOR for SMM for women with anemia versus those without was 8.56 (CI: 4.89–14.97) in rural areas, two times higher than in metro areas (aOR 3.87; CI: 3.09–4.86). Kentucky Appalachian region (aOR 1.90; CI: 1.46–2.47), Black race (aOR 1.30; CI: 1.02–1.66), history of cesarean section (aOR 1.28; CI: 1.07–1.52), hypertension (aOR 10.55; CI: 5.67–19.62), and opioid use (aOR 1.72; CI: 1.19–2.47) were significantly associated with SMM. Conclusion Rural women in Kentucky are at an increased risk for SMM. Quality and safety programming should specifically address the needs of isolated subpopulations. Women living in rural areas are more likely to experience SMM given an anemia diagnosis. The underlying cause and clinical management of anemia may differ between rural and urban areas.

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Section: Discussionmentioning

confidence: 99%

Rural residency as a risk factor for severe maternal morbidity

Hansen

Slavova

O’Brien

2021

The Journal of Rural Health

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“…This included a recommendation that all patients should be evaluated for PPH risk, ideally in the antepartum, intrapartum, and postpartum periods. Such recognition may facilitate delivery planning, earlier recognition, and more aggressive intervention when major PPH occurs [3]. Many PPH risk factors have been evaluated in the obstetric literature, and after initial development and then validation, a list of "high-risk" hemorrhage criteria have been published that capture 85% of major PPHs [4].…”

Section: Patient Identification: Risk Factorsmentioning

confidence: 99%

“…The absolute risk of major PPH is very low, at about 1-2%, and even with a 2-to 4-fold elevated risk, patients found to be at-risk will still have a low chance of requiring a major hemorrhage protocol. Alternatively, the use of risk factor triaging can miss 40% of patients who have a major hemorrhage but had no identified risk factors upon admission to the labor unit [3]. One group of researchers attempted to address this recently by building a prediction model for transfusion at CD [7].…”

Section: Patient Identification: Risk Factorsmentioning

confidence: 99%

“…Underrecognition of major blood loss has been cited as a significant contributor to hemorrhagic morbidity. Therefore, the National Partnership for Maternal Safety recommended using quantitative blood loss (QBL) measurement in place of visual blood loss estimations (EBL) [3]. This can come in the form of volumetric assessment, with which conical, graduated patient drapes or suction canisters are used to collect and measure blood; gravimetric systems, with which bloodsoaked sponges, drapes, and other items are weighed; or a combination of the two.…”

Section: Diagnosis: Blood Loss and Maternal Vital Signsmentioning

confidence: 99%

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Postpartum Hemorrhage: What’s New?

Markley

Carusi

2019

Curr Obstet Gynecol Rep

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Purpose of Review Postpartum hemorrhage (PPH) remains an important cause of maternal morbidity and mortality in the USA and in particular worldwide. Recent epidemiological studies have enhanced our ability to identify risk factors for PPH. Novel diagnostic, surgical, and pharmaceutical techniques present opportunities for improving our care of patients with PPH.Recent Findings This review aims to highlight recent primary research in the field of PPH. Large studies have refuted some assumed risk factors for PPH, including high body mass index and scheduled repeat cesarean delivery. Non-white race is an increasingly important risk factor for major maternal morbidity in the USA. New studies evaluated the role of tranexamic acid, point-of-care tests such as rotational thromboelastometry, uterotonic agents, and cell salvage in the management of PPH. Summary Attention to and preparation for PPH, especially in patients with significant risk factors, may allow early intervention and improved patient outcomes. Obstetric units should have protocols that use uterotonic agents for PPH prevention and treatment, and tranexamic acid for treatment only. Centers treating the highest risk patients may benefit from having point-ofcare testing and cell salvage available.

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“…In recognition of this important threat to maternal health, in 2015 the National Partnership for Maternal Safety created a consensus bundle of guidelines for readiness, prevention, recognition, and prompt response for PPH. This bundle, the first of its kind, called for improved recognition of risk factors and mitigation of outcomes of women who experienced PPH with the goal of increasing standardization for PPH management [2].…”

Section: Introductionmentioning

confidence: 99%

National trends in tranexamic acid use in the peripartum period, 2015–2019

Ahmadzia

Hynds

Amdur

et al. 2020

J Thromb Thrombolysis

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Background: To measure trends in the use of tranexamic acid (TXA) during delivery in the United States and to evaluate demographic data and morbidity outcomes among these patients. Methods:This retrospective cohort study includes data from 19 hospitals in the Universal Health Services network. We compared rates of TXA use between January 2015 and June 2019 across geographic sectors. We also evaluated associations of demographic variables and perinatal outcomes of women who received TXA.Results: 209 cases of TXA use were found from analysis of 101,564 deliveries. TXA use increased over time and rates were higher in the West than in Central and East; the slope of increase over years did not differ between regions. Women who received TXA were more likely to have a history of postpartum hemorrhage (59 (28.2%) vs. 2,290 (2.2%), P<0.0001) but were not more likely to have a chronic disease, including diabetes mellitus, hypertension and heart disease. Women who received TXA were more likely to have estimated blood loss greater than or equal to 1000 mL (adjusted odds ratio (aOR) 15.3; 95% CI 11.1-21.1; P<0.0001). Likelihood of venous thromboembolism was not significantly increased in TXA recipients (aOR 2.0; 95% CI 0.3-14.6; P=0.49).Terms of use and reuse: academic research for non-commercial purposes, see here for full terms. https://www.springer.com/aamterms-v1

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National Partnership for Maternal Safety: Consensus Bundle on Obstetric Hemorrhage

Cited by 64 publications

References 0 publications

Rural residency as a risk factor for severe maternal morbidity

Rural residency as a risk factor for severe maternal morbidity

Postpartum Hemorrhage: What’s New?

National trends in tranexamic acid use in the peripartum period, 2015–2019

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