Reduction of Severe Maternal Morbidity From Hemorrhage Using a State Perinatal Quality Collaborative

Main, Elliott K.; Cape, Valerie; Abreo, Anisha; Vasher, J.; Woods, Amanda; Carpenter, Andrew; Gould, Jeffrey B.

doi:10.1097/01.aoa.0000527017.02135.a6

Cited by 131 publications

(70 citation statements)

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“…Previous research has shown that implementing maternal safety bundles for obstetric hemorrhage can effectively reduce severe maternal morbidity. 31 Broader adoption of such safety bundles and assessment of similar strategies for reducing other obstetric complications and severe newborn morbidities merit further attention. We found two institutional characteristics associated with hospital performance in combined maternal and newborn outcomes-type of ownership and delivery volume.…”

Section: F I G U R Ementioning

confidence: 99%

Optimal maternal and neonatal outcomes and associated hospital characteristics

Campbell

Illuzzi

Lee

et al. 2018

Birth

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Background: This study aims to examine hospital variation in both maternal and neonatal morbidities and identify institutional characteristics associated with hospital performance in a combined measure of maternal and neonatal outcomes. Methods: Using the California Linked Birth File containing data from birth certificate and hospital discharge records, we identified 1 322 713 term births delivered at 248 hospitals during 2010-2012. For each hospital, a risk-standardized rate of severe maternal morbidities and a risk-standardized rate of severe newborn morbidities were calculated after adjusting for patient clinical risk factors. Hospitals were ranked based on combined information on their maternal and newborn morbidity rates. Results: Risk-standardized severe maternal and severe newborn morbidity rates varied substantially across hospitals (10th to 90th percentile range = 67.5-148.2 and 141.8-508.0 per 10 000 term births, respectively), although there was no significant association between the two (P = 0.15). Government hospitals (non-Federal) were more likely than other hospitals to be in worse rank quartiles (P value for trend = 0.004), whereas larger volume was associated with better rank among hospitals in the first three quartiles (P = 0.004). The most prevalent morbidities that differed progressively across hospital rank quartiles were severe hemorrhage, disseminated intravascular coagulation, and heart failure during procedure/surgery for mothers, and severe infection, respiratory complication, and shock/resuscitation for neonates. Conclusions: Hospitals with low maternal morbidity rates may not have low neonatal morbidity rates and vice versa, highlighting the importance of assessing joint maternal-newborn outcomes in order to fully characterize a hospital's obstetrical performance. Hospitals with smaller volume and government ownership tend to have less desirable outcomes and warrant additional attention in future quality improvement efforts. K E Y W O R D Schildbirth, hospital variation, morbidity, obstetric, quality and safety 290 | CAMPBELL Et AL.

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Section: F I G U R Ementioning

confidence: 99%

Optimal maternal and neonatal outcomes and associated hospital characteristics

Campbell

Illuzzi

Lee

et al. 2018

Birth

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“…On the other hand, quantitative blood loss (QBL) is laborious and time consuming but has a lower rate of error. Due to its accuracy, the use of QBL has been encouraged by the California Maternal Quality Care Collaborative (CMQCC) and the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) . This point should be considered in future studies.…”

Section: Discussionmentioning

confidence: 94%

How can methods of placental delivery in cesarean section affect perioperative blood loss? A randomized controlled trial of controlled cord traction versus manual removal of placenta

Altraigey

Ellaithy

Atia

et al. 2018

J of Obstet and Gynaecol

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“…Furthermore, neither early umbilical cord clamping nor umbilical cord traction have been shown to have a significant effect on the incidence or volume of postpartum hemorrhage (32). Additionally, in a Cochrane review, two trials examining nipple stimulation or breastfeeding did not demonstrate a difference in postpartum hemorrhage (33,34).…”

Section: What Should Be Considered In the Initial Evaluation And Manamentioning

confidence: 98%

Tranexamic acid as adjuvant treatment for postpartum hemorrhage: a systematic review protocol

Fahrenholtz

Bonanno²,

Martin

2019

JBI Database of Systematic Reviews and Implementation Reports

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Maternal hemorrhage, defined as a cumulative blood loss of greater than or equal to 1,000 mL or blood loss accompanied by signs or symptoms of hypovolemia within 24 hours after the birth process, remains the leading cause of maternal mortality worldwide (1). Additional important secondary sequelae from hemorrhage exist and include adult respiratory distress syndrome, shock, disseminated intravascular coagulation, acute renal failure, loss of fertility, and pituitary necrosis (Sheehan syndrome).Hemorrhage that leads to blood transfusion is the leading cause of severe maternal morbidity in the United States closely followed by disseminated intravascular coagulation (2). In the United States, the rate of postpartum hemorrhage increased 26% between 1994 and 2006 primarily because of increased rates of atony (3). In contrast, maternal mortality from postpartum obstetric hemorrhage has decreased since the late 1980s and accounted for slightly more than 10% of maternal mortalities (approximately 1.7 deaths per 100,000 live births) in 2009 (2, 4). This observed decrease in mortality is associated with increasing rates of transfusion and peripartum hysterectomy (2)(3)(4).The purpose of this Practice Bulletin is to discuss the risk factors for postpartum hemorrhage as well as its evaluation, prevention, and management. In addition, this document will encourage obstetrician-gynecologists and other obstetric care providers to play key roles in implementing standardized bundles of care (eg, policies, guidelines, and algorithms) for the management of postpartum hemorrhage.

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Reduction of Severe Maternal Morbidity From Hemorrhage Using a State Perinatal Quality Collaborative

Cited by 131 publications

References 0 publications

Optimal maternal and neonatal outcomes and associated hospital characteristics

Optimal maternal and neonatal outcomes and associated hospital characteristics

How can methods of placental delivery in cesarean section affect perioperative blood loss? A randomized controlled trial of controlled cord traction versus manual removal of placenta

Tranexamic acid as adjuvant treatment for postpartum hemorrhage: a systematic review protocol

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