Conference Coverage

Structured PPH management cuts severe hemorrhage


Key clinical point: Indicators of maternal morbidity decreased after a postpartum hemorrhage checklist was implemented.

Major finding: Severe postpartum hemorrhage rates fell from 18% to 9% (P = .035).

Study details: A prospective pre/post implementation study of 297 women experiencing postpartum hemorrhage.

Disclosures: The study authors reported no relevant financial conflicts of interest.

Source: Smith R et al. ACOG 2018, Abstract 26R.



– Taking a page from critical care, an obstetrical team that implemented a checklist-based management protocol for postpartum hemorrhage saw a significant drop in severe obstetric hemorrhage, with numeric reductions in other maternal outcomes.

The protocol, piloted in a single hospital, is now being rolled out in all 28 hospitals of a large, multistate health care system.

“Our medical critical care colleagues long ago abandoned the notion that physician judgment should guide the provision of basic and advanced cardiac life support in favor of highly specific and uniform protocols,” wrote first author Rachael Smith, DO, and her coauthors in the poster accompanying the presentation at the annual clinical and scientific meeting of the American Society of Obstetricians and Gynecologists.

“While existing guidelines outlining a general approach to postpartum hemorrhage are useful, recent data suggest that greater specificity is necessary to significantly impact morbidity and mortality,” they wrote.

When comparing outcomes for 9 matched months before and after implementation of the protocol, Dr. Smith and her collaborators found that rates of severe postpartum hemorrhage (PPH), defined as estimated blood loss (EBL) of at least 2,500 cc, were halved, dropping from 18% to 9% (P = .035).

Catherine Hermann, a medical student at the University of Arizona Kari Oakes

Catherine Hermann

Catherine Hermann, a coauthor and medical student at the University of Arizona, Phoenix, said in an interview during the poster session that a multidisciplinary team first developed a checklist, akin to that used during cardiac arrest or other instances where advanced cardiac life support protocols would be used.

“Patients with life-threatening illnesses seem to do better when their providers are following very structured, regimented protocols, and [advanced cardiac life support protocols] is probably the best example of that,” said Ms. Hermann.


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