Poster session II Diabetes, labor, medical-surgical-disease, obstetric quality & safety, prematurity, ultrasound-imaging: Abstracts 237 – 386| Volume 206, ISSUE 1, SUPPLEMENT , S155, January 01, 2012

328: Changes in care associated with introduction of a post-partum hemorrhage patient safety program


      To determine whether the introduction of a multi-pronged patient safety program regarding the management of post-partum hemorrhage (PPH) was associated with changes in patient care or outcomes.

      Study Design

      In August 2008, a patient safety program designed to assist with the management of PPH was instituted at a tertiary care urban maternity hospital. This program was composed of three principle components: (1) an educational initiative designed to improve the accuracy of blood loss estimation; (2) the training regarding and institution of a protocol for the management of post-partum hemorrhage; and (3) the institution of the active management of the third stage of labor. Patient care processes and outcomes were assessed for the six months prior to (period A) and six months after (period B) the institution of this program.


      There were 278 and 341 women diagnosed with PPH during periods A and B respectively. The women with PPH in both time periods were of similar age, height, weight, parity and gestational age. They also had similar frequencies of multiple gestations, placenta previas, preeclampsia, and operative deliveries. Conversely, several aspects of care were significantly different during the two time periods. Women who had a PPH after the program was instituted had significantly shorter third stages (P = .03); were significantly more likely to receive more than one type of uteronic (46% vs, 60%, P <.01) or a B-lynch suture (4.7% vs, 9.4%, P = .03); and were significantly less likely to undergo a manual extraction of their placenta (18 vs. 12%, P = .049). Patient outcomes, including the frequency of blood transfusion, hysterectomy, and ICU admission were similar between the two time periods.


      Introduction of a program aimed at optimizing management of postpartum hemorrhage resulted in several indications of a more quickly escalated response to postpartum hemorrhage. Further study will be required to determine whether this more rapid escalation translates into improved health outcomes.