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Does the Quality of Postpartum Hemorrhage Local Protocols Improve the Identification and Management of Blood Loss after Vaginal Deliveries? A Multicenter Cohort Study
| Content Provider | MDPI |
|---|---|
| Author | Olivier, Rivière Catherine, Crenn-Hébert Vendittelli, Françoise Barasinski, Chloé Correia, Caroline Da Costa Dreyfus, Michel Legrand, Anne Gerbaud, Laurent |
| Copyright Year | 2022 |
| Description | Substandard care, which can result from a delayed recognition of the severity of blood loss, can increase maternal morbidity. Our objectives were to assess the incidence of postpartum hemorrhage (PPH) and of second-line procedures in maternity units according to the quality of their PPH protocol. We used a mixed design, a prospective cohort (3442 women with PPH after vaginal delivery; February–July 2011), and an audit of the written protocols (177 French maternity units; September 2010–June 2011). A quality score was calculated for the protocol of each unit. Maternity units were classified into three categories according to this score: category 1 (total score: 0–8), category 2 (9–12.5), and category 3 (>12.5). The PPH incidence (>500 mL) was 3.2%, 3.3% and 4.6% among maternity units in categories 1, 2 and 3, respectively (p < 0.0001). The incidence of severe maternal morbidity (surgery and/or artery embolization and/or blood transfusion) was higher among maternity units in category 1 (54.8%; 95% CI: 51.9, 57.7) than in either category 2 (50.1%; 95% CI: 47.8, 52.5) or 3 (38.0%; 95% CI: 33.8, 42.4]) (p < 0.0001). The risks of severe maternal morbidity were lower for category 3 than category 1 and 2 (respectively, adjusted RR 0.68, 95% CI 0.60–0.86 and 0.77, 95% CI 0.68–0.87). Finally, maternity units with higher scores identified PPH better and used fewer curative second-line procedures. |
| Starting Page | 992 |
| e-ISSN | 22279032 |
| DOI | 10.3390/healthcare10060992 |
| Journal | Healthcare |
| Issue Number | 6 |
| Volume Number | 10 |
| Language | English |
| Publisher | MDPI |
| Publisher Date | 2022-05-27 |
| Access Restriction | Open |
| Subject Keyword | Healthcare Obstetrics and Gynecology Blood Transfusion Clinical Practice Guidelines Postpartum Hemorrhage Protocol Severe Maternal Morbidity Vaginal Delivery |
| Content Type | Text |
| Resource Type | Article |
