Quality Improvement Opportunities Identified Through Case Review of Pregnancy-Related Deaths From Obstetric Hemorrhage

Seacrist, Marla J.; VanOtterloo, Lucy R.; Morton, Christine H.; Main, Elliott K.

doi:10.1016/j.jogn.2019.03.002

Cited by 22 publications

(17 citation statements)

References 19 publications

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“…The inaccuracy of provider-based blood loss estimation during cesarean births is known as a primary cause of delayed recognition and response to PPH, contributing to maternal morbidity and mortality. 6 The American College of Obstetricians and Gynecologists and the Association of Women's Health, Obstetric and Neonatal Nurses promote the replacement of estimated blood loss (EBL) with QBL during every birth to promote improved patient outcomes. 3,7 Although adopting QBL strategies in the birthing suite has received national focus, implementation within the perioperative environment is much less common.…”

Section: Driver For Changementioning

confidence: 99%

“…Before the project, OB and anesthesia professionals subjectively estimated blood loss using visual assessment and clinical experience. The inaccuracy of provider‐based blood loss estimation during cesarean births is known as a primary cause of delayed recognition and response to PPH, contributing to maternal morbidity and mortality 6 . The American College of Obstetricians and Gynecologists and the Association of Women’s Health, Obstetric and Neonatal Nurses promote the replacement of estimated blood loss (EBL) with QBL during every birth to promote improved patient outcomes 3,7 .…”

Section: Driver For Changementioning

confidence: 99%

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Quantitative Blood Loss Implementation in Cesarean Births

Hendrixson¹,

Quinn²,

Haughton³

2022

AORN Journal

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Section: Driver For Changementioning

confidence: 99%

Section: Driver For Changementioning

confidence: 99%

Quantitative Blood Loss Implementation in Cesarean Births

Hendrixson¹,

Quinn²,

Haughton³

2022

AORN Journal

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“…Third, we explored whether the intensity of ICD-9 coding varied by quartiles for risk-adjusted hospital PPH rates (Appendix S4). Hospitals in the lowest quartile had a slightly lower median number of ICD-9 codes per delivery hospitalization than hospitals in the highest quartile (median [interquartile range]: 6 [4][5][6][7][8] vs. 8 [6][7][8][9][10][11]; p < 0.001; Appendix S4).…”

Section: Secondary Analysesmentioning

confidence: 99%

“…Given that maternal mortality reviews report deficiencies in system‐wide approaches to PPH prevention, detection, and management, 8,9 quantifying the extent of and factors associated with hospital‐level variation in risk‐adjusted PPH rates is one approach to indirectly assess if the maternal quality of care related to PPH prevention and management varies across hospitals. Examining hospital risk‐adjusted rates of PPH is also of significant interest to hospital administrators, policymakers, and payors because Joint Commission accredited US hospitals are required to adopt new standards of care related to the prevention and management of PPH 10 .…”

Section: Introductionmentioning

confidence: 99%

Hospital‐level variation in rates of postpartum hemorrhage in California

et al. 2022

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Background: To examine the extent of hospital-level variation in riskadjusted rates of postpartum hemorrhage (PPH). Study design and Methods: We performed a cross-sectional study examining live births in 257 California hospitals between 2011 and 2015 using linked birth certificate and maternal discharge data. PPH was measured using International Classification of Diseases Codes version 9. Mixed-effects logistic regression models were used to examine the presence and extent of hospitallevel variation in PPH before and after adjustment for patient-level risk factors and select hospital characteristics (teaching status and annual delivery volume). Risk-adjusted rates of PPH were estimated for each hospital. The extent of hospital variation was evaluated using the median odds ratio (MOR) and intraclass correlation coefficient (ICC).Results: Our study cohort comprised 1,904,479 women who had a live birth delivery hospitalization at 247 hospitals. The median, lowest, and highest hospital-specific rates of PPH were 3.48%, 0.54%, and 12.0%, respectively. Similar rates were observed after adjustment for patient and hospital factors (3.44%, 0.60%, and 11.48%). After adjustment, the proportion of the total variation in PPH rates attributable to the hospital was low, with a MOR of 2.02 (95% confidence interval [CI]: 1.89-2.15) and ICC of 14.3% (95% CI: 11.9%-16.3%). Discussion: Wide variability exists in the rate of PPH across hospitals in California, not attributable to patient factors, hospital teaching status, and hospital annual delivery volume. Determining whether differences in hospital quality of care explain the unaccounted-for variation in hospital-level PPH rates should be a public health priority.

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“…3 Most deaths due to PPH involve delayed diagnosis caused by underestimation of blood loss resulting into delayed management. 4 An ideal method for estimation of blood loss at delivery should be accurate but very accurate methods like dye dilution technique, change in peripartum haemoglobin, red blood cell labelling and photospectrometry involve blood extraction or injection of some substance and therefore are not practical or affordable particularly in low and middle income countries (LMICs). The recently reported use of artificial intelligence (AI) namely Triton too is not feasible in these settings.…”

Section: Introductionmentioning

confidence: 99%

Visual estimation of blood loss versus quantification of blood loss after vaginal birth using an innovative drape: a prospective study

Mishra

Dhruw

Mishra

et al. 2020

Int J Reprod Contracept Obstet Gynecol

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Background: This study was done to compare the accuracy of visual estimation of blood loss (EBL) and quantitative assessment of blood loss (QBL, sum of volumetric and gravimetric assessment) against a reference standard i.e. calculated QBL (C-QBL) and also with each other after vaginal birth.Methods: Prospective observational cohort study conducted at Pt. JNM medical College Raipur, Chhattisgarh, India and involved 101 low risk women after vaginal birth. Women were allocated alternately to EBL or QBL group (volumetric component of measured blood loss was done with an innovative low cost drape prepared with a plastic apron at the point of care. Gravimetric component was measured by weight difference of the mops and pads before and after use). C-QBL was calculated for each case with a standard formula. Main outcome measure was comparing the correlation coefficient of EBL and QBL each with C-QBL.Results: The mean blood loss in 51 women of EBL group and 50 women of QBL group was 275.29 ml and 380 ml respectively. Pearson’s correlation coefficient (r) of EBL with C-QBL was 0.4984 (weak correlation) compared to that of QBL with C-QBL (r=0.9093, strong positive correlation). The error of underestimation by EBL compared to QBL was 28% (mean=104.71 ml p<0.0001). The relative risk (RR) of underestimating blood loss of >500 ml by EBL method was 5 (95% CI .605-41.3).Conclusions: Visual EBL should be replaced with QBL for measurement of postpartum blood loss. Using innovative under-buttock low cost drape greatly helps in routine QBL.

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Quality Improvement Opportunities Identified Through Case Review of Pregnancy-Related Deaths From Obstetric Hemorrhage

Cited by 22 publications

References 19 publications

Quantitative Blood Loss Implementation in Cesarean Births

Quantitative Blood Loss Implementation in Cesarean Births

Hospital‐level variation in rates of postpartum hemorrhage in California

Visual estimation of blood loss versus quantification of blood loss after vaginal birth using an innovative drape: a prospective study

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