Institution of a Postpartum Hemorrhage Bundle at an Academic Center Does Not Immediately Reduce Maternal Morbidity [36O

Abstract

INTRODUCTION: Obstetric hemorrhage is a leading cause of morbidity and mortality. The Council for Patient Safety in Women's Health released a postpartum hemorrhage (PPH) bundle in 2015 designed to improve patient safety and reduce the use of blood products. We sought to assess whether institution of such a bundle could improve maternal morbidity in our population. METHODS: Pre-intervention data (PRE) data was collected on all deliveries at the Hospital of the University of Pennsylvania between 10/15/13 and 12/15/13. Deliveries were included if estimated blood loss (EBL), admission hemoglobin, and 12-hour postpartum hemoglobin were collected. A two-pronged, multidisciplinary educational and procedural intervention related to PPH, including institution of quantitative blood loss, was instituted from 3/2015 to 6/2015. Post-intervention data (POST) was collected on all deliveries from 10/20/2015 to 12/20/2015. Chi-square was used to compare proportions. RESULTS: 592 of 626 (95%) PRE and 583 of 613 (95%) POST deliveries were included. The rates of PPH by EBL ≥1000 cc and by 3 g hemoglobin drop were not significantly different from PRE to POST (9.0% vs 12.2%, p=0.07 and 10.5% vs. 13.5%, p=0.10, respectively). There was no significant change in transfusion rate (3.4% vs. 5.1% p=0.13). Use of uterotonics was reduced from 9.8% to 6.3% from PRE to POST (p=0.03). CONCLUSION: While institution of a PPH bundle is designed to improve the morbidity of PPH, our data demonstrates that it cannot be expected to do so within 6 months of implementation. Further studies will need to assess the long term effects of such a resource intensive protocol.