Are Postpartum Hemorrhage Kits Enough? Evaluating Their Impact on Maternal Blood Loss [39C

Abstract

INTRODUCTION: Postpartum hemorrhage (PPH) is a common complication and preventable maternal mortality. We hypothesized our units PPH medication and supply kits would lead to lowered and sustained blood loss in PPH cases. METHODS: Retrospective cohort study of PPH cases 18 months prior to kits (PRE), 12 months after (POST-1), 12-24 months after(POST-2). Cases include women ≥18 years with PPH in perinatal database or uterotonics noted in pharmacy database. PPH defined as >500ml estimated blood loss (EBL) at vaginal, >1000ml EBL at cesarean delivery. Primary outcome was median blood loss measured qualitatively through EBL and quantitatively through hemoglobin change (Hgb). Time to medication administration was assessed. ANOVA, chi-squared, and Fisher’s exact analyses used as appropriate. RESULTS: 195 women included (86 PRE, 42 POST-1, 67 POST-2). Groups had similar maternal age, BMI, parity, gestational age, rates of induction, and cesarean delivery. Total mean EBL vaginal deliveries (PRE 983 ±497ml, POST-1 1,035 ± 447ml, POST-2 1,075 ± 565ml, P=0.64) and cesareans (1,630 ± 755ml, 1,480 ± 780ml, 2,025 ± 1,419ml, P=0.36) were not significantly different between groups. Change in Hgb from delivery to postpartum day 1 was not significantly different (P=0.19). Times to administration and rates of medication use were similar between groups for Methergine, Carboprost, oxytocin, misoprostol, and blood transfusion. CONCLUSION: Introduction of PPH kits alone not associated with lower EBL or improved time to uterotonic administration. This work highlights importance of evaluating the impact of quality improvement projects after implementation. Using only portion of bundle may not lead to improved patient outcomes.