Obstetric hemorrhage remains one of the leading causes of maternal mortality in the U.S., accounting for well over half of severe maternal morbidities. Despite being largely preventable and most often treatable, obstetric hemorrhage is still recognized as the most common serious complication of childbirth, claiming 100,000+ mothers’ lives in the U.S. every year.
Worldwide, a massive obstetric hemorrhage, resulting from the failure of normal obstetrical, surgical and/or systemic hemostasis, is responsible for 25% of the estimated 358,000 maternal deaths each year.
The Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) has highlighted this alarming issue, noting that every 10 minutes a woman in the United States almost dies of pregnancy-related complications, recognizing that postpartum hemorrhage is a leading cause of these complications and estimating that 2.9% of the women who give birth in the U.S. will bleed too much.
With roughly 125,000 women per year being affected, the issue continues to stand as a growing concern for mothers and providers. In the last 10 years, there was a 183% increase in the number of women who had a blood transfusion around the time they gave birth.
Timing and Patient Education are Key to Survival Rates
An obstetric hemorrhage may occur before or after delivery, but more than 80% of cases occur postpartum.
Postpartum hemorrhages can be categorized into two groups—early postpartum hemorrhage and late postpartum hemorrhage. Early postpartum hemorrhages (occurring within 24 hours of delivery) represent the clear majority of obstetrical hemorrhages, with uterine atony accounting for 70% to 80% of all hemorrhages.
Though not as common as early postpartum hemorrhages, late postpartum hemorrhages (occurring 24 hours to 6 weeks post-delivery) should also be given a great deal of attention, especially with the growing rate of women delivering outside the hospital. This makes patient education for late postpartum hemorrhages especially important, as addressed in AWHONN’s POST-BIRTH program resources (included in the latest version of the Relias OB, formerly GNOSIS™, obstetrical hemorrhage course).
Recognizing that over half of maternal deaths occur within the first year after childbirth, AWHONN has developed the POST-BIRTH Warning Signs Education Program to help nurses and clinicians implement this life-saving program at their facility. The POST-BIRTH Warning Signs Education Program consists of multiple components:
- An online education course with CNE offering
- Implementation Toolkit
- The Post-Birth Warning Signs Magnet and Magnet templates
- Save Your Life handouts in English, Spanish, Arabic and Mandarin-Chinese translations
This page provides more information and instructions for obtaining the specific materials listed above.
The common belief that obstetric hemorrhages are largely preventable and most often treatable, fundamentally depends on the timely identification and treatment delivered by the labor and delivery team.
Four Key Elements for Improvement
Many national and worldwide quality organizations have developed toolkits and guidelines to address the need for improved obstetric hemorrhage prevention and treatment, such as the California Maternal Quality Care Collaborative’s (CMQCC) OB Hemorrhage Toolkit. Additionally, the American College of Obstetricians and Gynecologists (ACOG) highlights the following four key elements as a strong basis for hospitals and health systems:
- Recognition and prevention for every patient through risk assessment and universal active management of third stage of labor.
- Readiness by every unit to include a blood bank (equipped with a functioning massive transfusion protocol), cart and medication kit, and a designated hemorrhage team with multidisciplinary education and team training.
- Response to every hemorrhage through standardized checklist and proper support for patients, families, and affected healthcare workers for all significant hemorrhages.
- Reporting on system’s learning by every unit including the implementation of a culture incorporating huddles and debriefs, a multidisciplinary review of significant hemorrhages, and the monitoring of outcome and process metrics.
How One Health System is Approaching Obstetric Hemorrhage
In an impressive demonstration of commitment, an OB team at a large national health system has spent more than a decade addressing obstetric hemorrhage. In 2014, the system strengthened efforts to focus on obstetric hemorrhage prevention and treatment by implementing a blended learning model, which included Relias OB (formerly GNOSIS™).
By effectively translating a paper protocol into an intuitive electronic workflow, the system improved patient safety by understanding how to: identify risk factors and calculate risk scores, communicate risk level throughout the team, prepare for hemorrhages with easily accessible preselected medications and lab order sets, and most importantly—safely respond to obstetric hemorrhages because of improved education and team training.
National Push for Progress
To advance progress on obstetric hemorrhage improvement, quality organizations are setting new maternal safety standards—focusing on the prevention, early recognition, and timely treatment. Effective July 2020, hospitals that are Joint Commission accredited will be held accountable to demonstrate adherence to new requirements focused on improving the quality and safe care provided to women during all stages of pregnancy and postpartum—particularly in the areas of obstetrical hemorrhage and severe hypertensive/preeclampsia.
To prepare hospitals to meet these new standards, The Joint Commission has issued a new R3 Report that provides guidelines for the 13 new elements of performance (EPs) that fall under the standards. The report provides the requirement, rationale and reference for each EP.
How Relias Can Help
Relias OB (formerly GNOSIS™) is a comprehensive program designed to improve quality and patient safety in five high-acuity obstetrical areas: obstetric hemorrhage, fetal assessment and monitoring, hypertensive disorders, shoulder dystocia, and promoting vaginal birth. Reviewed and approved by AWHONN, this multidisciplinary education solution was developed for advanced obstetric practitioners, including physicians, nurses, and certified nurse-midwives.