National Partnership for Maternal Safety

Main, Elliott K.; Goffman, Dena; Scavone, Barbara M.; Low, Lisa Kane; Bingham, Debra; Fontaine, Patricia; Gorlin, Jed B.; Lagrew, David C.; Levy, Barbara

doi:10.1097/aog.0000000000000869

Cited by 317 publications

(39 citation statements)

References 43 publications

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“…38 Timely recognition, an organized response, availability of a massive transfusion protocol, and appropriate treatment may reduce risk for death from this complication. 36 Institutional readiness based on implementing strategies that anticipate and optimize management of postpartum hemorrhage may be more important in avoiding failure to rescue from hemorrhage than volume of the complication experienced within a center. Major national efforts to reduce maternal mortality such as the United Kingdom's Confidential Enquiries into Maternal Death utilize both epidemiologic surveillance data as well as comprehensive mortality case reviews in fashioning recommendations to improve outcomes.…”

Section: Discussionmentioning

confidence: 99%

Hospital delivery volume, severe obstetrical morbidity, and failure to rescue

Friedman

Ananth

Huang

et al. 2016

American Journal of Obstetrics and Gynecology

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Background In the setting of persistently high risk for maternal mortality and severe obstetric morbidity, little is known about the relationship between hospital delivery volume and maternal outcomes. Objective The objectives of this analysis were (i) to determine maternal risk for severe morbidity during delivery hospitalizations by hospital delivery volume in the United States; and (ii) to characterize, by hospital volume, the risk for mortality in the setting of severe obstetrical morbidity – a concept known as failure to rescue. Study Design This cohort study evaluated 50,433,539 delivery hospitalizations across the United States from 1998 to 2010. The main outcome measures were (i) severe morbidity defined as a composite of any one of fifteen diagnoses representative of acute organ injury and critical illness, and (ii) failure to rescue, defined as death in the setting of severe morbidity. Results The prevalence of severe morbidity rose from 471.2 to 751.5 cases per 100,000 deliveries from 1998 to 2010, an increase of 59.5%. Failure to rescue was highest in 1998 (1.5%), decreased to 0.6% in 2007, and rose to 0.9% in 2010. In models adjusted for comorbid risk and hospital factors, both low and high annualized delivery volume were associated with increased risk for failure to rescue and severe morbidity. However, the relative importance of hospital volume for both outcomes compared to other factors was relatively small. Conclusions While low and high delivery volume are associated with increased risk for both failure to rescue and severe maternal morbidity, other factors, in particular characteristics of individual centers, may be more important in determining outcomes.

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Section: Discussionmentioning

confidence: 99%

Hospital delivery volume, severe obstetrical morbidity, and failure to rescue

Friedman

Ananth

Huang

et al. 2016

American Journal of Obstetrics and Gynecology

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“…The increased risk associated with these factors supports the practice of universal screening of obstetrical patients for hemorrhage risk advocated by the National Partnership for Maternal Safety and other leadership organizations as a “hedge” to reduce risk in the setting of severe hemorrhage by making blood products available, notifying consultants and support personnel, and tailoring a patient-specific management plan. 12 In this context, the “low” and “moderate” risk groups, while excluding patients at high risk for morbidly adherent placenta and thus the highest probability for hysterectomy, included patients at relatively high risk for hysterectomy based on other risk factors.…”

Section: Discussionmentioning

confidence: 99%

“…Other measures to improve hemorrhage-related outcomes such as instituting up-to-date trauma-based massive transfusion protocols may be critical to improving cesarean hysterectomy outcomes. 2,12 …”

Section: Discussionmentioning

confidence: 99%

“…If peripartum hysterectomy is demonstrated to be (i) relatively common on a population basis for low-risk women, and (ii) only partially accounted for by risk factors, effective hospital-level safety planning would require both routine risk assessment of obstetrical patients as well as general preparedness for catastrophic hemorrhage, an approach supported by major maternal safety initiatives, including hemorrhage bundle recommendations from the National Partnership for Maternal Safety. 12 …”

Section: Introductionmentioning

confidence: 99%

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Population-based risk for peripartum hysterectomy during low- and moderate-risk delivery hospitalizations

Friedman

Wright

Ananth

et al. 2016

American Journal of Obstetrics and Gynecology

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BACKGROUND Postpartum hysterectomy is an obstetric procedure that carries significant maternal risk that is not well characterized by hospital volume. OBJECTIVE The objective of this study was to determine risk for peripartum hysterectomy for women at low and moderate risk for the procedure. STUDY DESIGN This population-based study used data from the Nationwide Inpatient Sample to characterize risk for peripartum hysterectomy. Women with a diagnosis of placenta accreta or prior cesarean and placenta previa were excluded. Obstetrical risk factors along with demographic and hospital factors were evaluated. Multivariable mixed-effects log-linear regression models were developed to determine adjusted risk. Based on these models receiver operating characteristic curves were plotted, and the area under the curve was determined to assess discrimination. RESULTS Cesarean hysterectomy occurred in 1 in 1913 deliveries. Risk factors associated with significant risk for hysterectomy included mode of delivery, stillbirth, placental abruption, fibroids, and antepartum hemorrhage. These factors retained their significance in adjusted models: The risk ratio for stillbirth was 3.44 (95% confidence interval (CI) 2.94–4.02), abruption 2.98 (95% CI 2.52–3.20), fibroids 3.63 (95% CI 3.22–4.08), and antepartum hemorrhage 7.15 (95% CI 6.16–8.32). The area under the curve (AUC) for the model was 0.833. CONCLUSION Cesarean hysterectomy is a relatively common event that hospitals providing routine obstetric care should be prepared to manage. That specific risk factors are highly associated with risk for hysterectomy supports routine use of hemorrhage risk-assessment tools. However, given that a significant proportion of hysterectomies will be unpredictable, the availability of rapid transfusion protocols may be necessary for hospitals to safely manage these cases.

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“…In order to decrease the frequency of PPH, clinical guidelines have been published to optimize PPH management practices (ACOG, 2006; American Society of Anesthesiologists Task Force on Perioperative Blood Management, 2015; Main et al, 2015). Obstetric and anesthetic care providers may also obtain updates about PPH management from literature review and other educational forums, such as seminars and conferences.…”

Section: Introductionmentioning

confidence: 99%

Knowledge of blood loss at delivery among postpartum patients

Farber

Miller

Ramachandran

et al. 2016

PeerJ

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BackgroundPostpartum hemorrhage (PPH) is a leading cause of obstetric morbidity. There is limited understanding of patients’ knowledge about blood loss at delivery, PPH, and PPH-related morbidities, including transfusion and anemia.MethodsWe surveyed 100 healthy postpartum patients who underwent vaginal or cesarean delivery about blood loss, and whether they received information about transfusion and peripartum hemoglobin (Hb) testing. Responses were compared between women undergoing vaginal delivery vs. cesarean delivery; P < 0.05 considered as statistically significant.ResultsIn our cohort, 49 women underwent vaginal delivery and 51 women underwent cesarean delivery. Only 29 (29%) of women provided blood loss estimates for their delivery. Women who underwent cesarean delivery were more likely to receive clear information about transfusion therapy than those undergoing vaginal delivery (43.1% vs. 20.4% respectively; P = 0.04). Women who underwent vaginal delivery were more likely to receive results of postpartum Hb tests compared to those undergoing cesarean delivery (49% vs. 29.4%; P = 0.02).ConclusionOur findings suggest that women are poorly informed about the magnitude of blood loss at delivery. Hematologic information given to patients varies according to mode of delivery. Further research is needed to better understand the clinical implications of patients’ knowledge gaps about PPH, transfusion and postpartum anemia.

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National Partnership for Maternal Safety

Cited by 317 publications

References 43 publications

Hospital delivery volume, severe obstetrical morbidity, and failure to rescue

Hospital delivery volume, severe obstetrical morbidity, and failure to rescue

Population-based risk for peripartum hysterectomy during low- and moderate-risk delivery hospitalizations

Knowledge of blood loss at delivery among postpartum patients

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