Effectiveness of Maternal Safety Bundle for Obstetric Hemorrhage at a Large U.S. Military Hospital [15M

Abstract

INTRODUCTION: Postpartum hemorrhage is one of the leading causes of maternal deaths worldwide. Attempts to remedy this problem have led to the implementation of multiple maternal safety bundles, of which one was recently implemented at Womack Army Medical Center at Fort Bragg, NC. The goal of our study is to determine the effectiveness of this bundle in predicting postpartum hemorrhage in a military population. METHODS: Our study included patients that delivered from March through December 2017, who were deemed either moderate or high risk for postpartum hemorrhage. We looked at blood transfusion rates and risk factors for receiving transfusions. Numerical variables were compared using Student’s t or Wilcoxon Rank Sum as appropriate. Categorical variables were compared with the χ2 Test of Independence or Fisher’s Exact. RESULTS: There were 423 patients who were considered ‘moderate’ risk (78.7%) or ‘high’ risk (21.3%) for postpartum hemorrhage. Of patients considered high risk, 11.1% required a blood transfusion, whereas significantly fewer patients classified as moderate risk required a transfusion (3.9%, P=.0150). The only significant risk factors for blood transfusion in this sample were patients with history of a prior postpartum hemorrhage (P=.0027, assessed antepartum) and less than 70,000 platelets assessed intrapartum (P=.0082). CONCLUSION: Our study shows that this bundle for obstetric hemorrhage was able to predict a higher rate of transfusion for those deemed high risk. Interestingly, our analysis showed only 2 risk factors of 26 were found to be statistically significant for blood transfusion.