OBSTETRICAL HEMORRHAGE: A PREVENTABLE CAUSE OF MATERNAL MORBIDITY
In this blog, I’ll be reviewing the national, and New York State statistics related to maternal mortality associated with obstetrical hemorrhage. I’ll also highlight one of the risk factors associated with obstetrical hemorrhage, and discuss the standards of care that should be employed to mitigate the risk of maternal morbidity and mortality.
Statistics: Obstetrical hemorrhage is a preventable cause of maternal morbidity and mortality and continues to be one of the leading causes of maternal death in the U.S.
How the U.S. compares to 10 other developed countries:
In New York State, postpartum hemorrhage is the 2nd most frequently reported postpartum complication, and accounted for 29% (18) of maternal deaths between 2012-2013 according to the NYS Maternal Morbidity and Mortality Review Report (2017).
Prolonged oxytocin exposure as a risk factor: In a recent (published May, 2022) retrospective cohort study performed by Boston University School of Medicine, prolonged (greater than or equal to 12 hours) oxytocin exposure for induction of labor increased the risk of obstetrical hemorrhage by 52% compared to those women exposed for less than 12 hours. Use of obstetrical risk assessment tools alert the perinatal team to the risk of obstetrical hemorrhage and prompts evidence-based interventions.
The importance of standardized safety bundles: The American College of Obstetricians and Gynecologists (ACOG) recommends the use of the Obstetrical Safety Bundle as a means to guide standardized management of obstetrical emergencies associated with maternal morbidity and mortality in accordance to evidence-based practice. ACOG’s Safe Motherhood Initiative (SMI) focuses on the four leading causes of maternal death: maternal sepsis, obstetric hemorrhage (severe bleeding), venous thromboembolism (blood clots), and severe hypertension in pregnancy (high blood pressure).
The Obstetrical Hemorrhage Safety Bundle includes:
- Risk assessments: prenatal, antepartum, labor & delivery, and postpartum.
- Use of a staged obstetrical hemorrhage checklist to guide interventions in real-time.
- Team debriefing recommendations and a standardized debriefing form.
- Suggested standardized obstetrical hemorrhage tool kit.
- Recommendation to perform quantitative blood loss assessment (QBL) with every delivery.
The Joint Commission Perinatal Safety Standards: Effective January 1, 2021, the Joint Commission implemented new perinatal safety standards required of all Joint Commission accredited hospitals. One of the new standards aims to improve care for women experiencing maternal hemorrhage. The Joint Commission requirements focus on evidence-based written procedures, education, training, and drills for staff and providers, education for patients and families, and quality review. The requirement also focuses on evidence-based risk assessments and hemorrhage supply kits.
References:
ACOG’s Obstetrical Hemorrhage Safety Bundle. https://www.acog.org/community/districts-and-sections/district-ii/programs-and-resources/safe-motherhood-initiative/obstetric-hemorrhage
MedPage Today. 2022. https://www.medpagetoday.com/meetingcoverage/acog/98676
NYS Department of Health. 2017. NYS Morbidity and Mortality Review Report
OECD Health Data. 2020
P.S. Comment and share your experience with a maternal death case associated with obstetrical hemorrhage. What were the deviations in the standards of care?