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84: Comprehensive maternal hemorrhage protocols reduce utilization of blood products and improve patient safety

      Objective

      To improve patient safety and address a source of major morbidity, we initiated a comprehensive maternal hemorrhage (CHP) protocol within a large health care system with 31 different delivery units with >60,000 system-wide annual births. The objective of this study was to determine if the CHP reduced the severity of obstetrical hemorrhage.

      Study Design

      Patients were assigned to one of four protocol stages based on the degree of blood loss: Stage 0: normal ante/postpartum assessment; Stage 1: bleeding greater than expected for vaginal delivery (500mL) or C-section (1000mL); Stage 2: bleeding not responding to conservative measures, and required physician presence, and Stage 3: blood loss in excess of 1500mL. Interventions and transfusion recommendations were specific to the patient's stage of blood loss. Two time periods were compared: a 2-month baseline, and a second 2- month assessment 6 months after system-wide implementation of the CHP. A dedicated perinatal nurse specialist at each facility prospectively collected outcomes data.

      Results

      There were 20,890 deliveries during the two study periods. Relative to baseline, there was a significant reduction in blood product utilization (p = 0.04), pRBCs 22.4%, platelets 31.4%, FFP 43.2% and cryoprecipitate 58.1%. The number of patients that required ≥4 units of pRBCs was reduced by 88%. There was a concomitant 50% reduction in the number of patient that required puerperal hysterectomy (p = 0.01).

      Conclusion

      Utilization of a CHP in a large health care system significantly reduced the number of blood products despite the fact that the protocol prescribed early transfusion. Further, there was a reduction in the severity of maternal hemorrhage, and the rate of puerperal hysterectomy. These findings suggest that protocol interventions reduced the need for aggressive surgical treatment and reduced maternal morbidity. These data support the implementation of systematic treatment protocols directed towards prevention and treatment of maternal hemorrhage.