Department of Obstetrics and Gynecology, Maternal and Child Health Research Program, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania.
Am J Perinatol. 2019 Jan;36(1):15-21. doi: 10.1055/s-0038-1629910. Epub 2018 Feb 19.
Obstetric hemorrhage is a leading cause of morbidity and mortality. We sought to assess whether institution of a postpartum hemorrhage (PPH) bundle could improve maternal morbidity in our population.
Preintervention data (PRE) was collected on all deliveries at Hospital of the University of Pennsylvania between October 15, 2013 and December 15, 2013. A two-pronged, multidisciplinary educational and procedural intervention related to PPH was instituted from March 2015 to June 2015. Postintervention data (POST) was collected on all deliveries from October 20, 2015 to December 20, 2015.
Note that 592 of 626 (95%) PRE and 583 of 613 (95%) POST deliveries were included. The rates of PPH by estimated blood loss (EBL) ≥ 1,000 mL and by 3 g hemoglobin drop were not significantly different from PRE to POST (9.0% versus 12.2%, = 0.07 and 10.5% versus 13.5%, = 0.10, respectively). There was no significant change in transfusion rate (3.4% versus 5.1%, = 0.13). Use of uterotonics was reduced from 9.8 to 6.3% from PRE to POST ( = 0.03).
While institution of a PPH bundle is designed to improve the morbidity of PPH, our data demonstrate that it cannot be expected to do so within 6 months of implementation. Further studies will need to assess the long-term effects of such a resource-intensive protocol, including perceptions of improved safety by all providers, nurses, and staff.
产后出血是导致产妇发病率和死亡率的主要原因。我们旨在评估在本地区实施产后出血（PPH）综合管理方案是否能够降低产妇发病率。
预干预阶段（PRE）数据采集于 2013 年 10 月 15 日至 12 月 15 日期间在宾夕法尼亚大学医院分娩的所有产妇。2015 年 3 月至 6 月实施了一项与 PPH 相关的、双管齐下的多学科教育和程序干预。2015 年 10 月 20 日至 12 月 20 日采集了干预后阶段（POST）的数据。
PRE 和 POST 分别纳入了 626 例和 613 例分娩中的 592 例（95%）和 583 例（95%）。根据估计失血量（EBL）≥1000ml 和血红蛋白下降 3g 的产后出血发生率 PRE 与 POST 相比无显著差异（9.0%比 12.2%，=0.07 和 10.5%比 13.5%，=0.10）。输血率无显著变化（3.4%比 5.1%，=0.13）。从 PRE 到 POST，缩宫素的使用率从 9.8%降至 6.3%（=0.03）。
虽然实施 PPH 综合管理方案旨在降低 PPH 的发病率，但我们的数据表明，在实施后的 6 个月内，这一方案并不能达到这一目标。还需要进一步研究来评估这种资源密集型方案的长期效果，包括所有提供者、护士和工作人员对安全性提高的认知。
