Multidisciplinary Care of a Woman Experiencing Obstetric Hemorrhage

Abstract

<h2>Poster Presentation</h2><h3>Background</h3> Abruptio placentae and uterine rupture can result in catastrophic outcomes for the mother and infant. In this case study, a uterine rupture resulted in a 100% abruption with fetal demise and obstetric hemorrhage. Using evidence‐based guidelines from the California Maternal Quality Care Collaborative toolkit for early identification and intervention in obstetric hemorrhage, the woman was managed by several nursing units, three physician groups, and numerous ancillary departments. This case reinforced the need for comprehensive education throughout a Level‐1 community hospital. <h3>Case</h3> A G3P2 woman with a prior cesarean birth and a prior vaginal birth after cesarean (VBAC) presented to the hospital with a board‐like abdomen and no fetal heart rate (FHR). She was taken for emergency cesarean and a uterine rupture and complete abruption were discovered. A complete blood count (CBC), chem panel, and coagulation studies were collected during the cesarean. Blood replacement was initiated quickly, and additional fluid and blood replacement continued throughout the hospital stay. The woman was admitted to the intensive care unit and was managed by obstetricians, hospitalists, intensive care unit, and obstetric staff. Actual blood loss totals were greater than 4000 mls in the first 24 hours. The woman did well, was discharged on the 5th postpartum day, and avoided hysterectomy. This case illustrated the multidisciplinary cooperation needed when responding to an obstetric emergency. As a result of this case, all staff and physicians have been educated about actual blood loss measurement and the importance of early fluid and blood replacement based on the California Maternal Quality Care Collaborative toolkit. Simulation training about obstetric hemorrhage is scheduled for all departments to improve the identification and intervention in hemorrhage to improve outcomes. <h3>Conclusion</h3> Implementation of a standardized, evidenced‐based toolkit for obstetric hemorrhage will improve patient outcomes and provide opportunities to intervene with fluid and volume replacement. Implementing multidisciplinary education throughout the hospital will allow staff to mobilize resources to care for these high‐risk women.