Wolfson Carrie, Angelson Jessica Tsipe, Atlas Robert, Burd Irina, Chin Pamela, Downey Cathy, Fahey Jenifer, Hoffman Susan, Johnson Clark T, Jones Monica B, Jones-Beatty Kimberly, Kasirsky Jennifer, Kirsch Daniel, Madan Ichchha, Neale Donna, Olaku Joanne, Phillips Michelle, Richter Amber, Sheffield Jeanne, Silldorff Danielle, Silverman David, Starr Hannah, Vandyck Rhoda, Creanga Andreea
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (Wolfson and Creanga).
Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (Angelson).
Am J Obstet Gynecol MFM. 2025 Feb;7(2):101589. doi: 10.1016/j.ajogmf.2024.101589. Epub 2025 Jan 2.
Obstetric hemorrhage is the leading cause of maternal mortality and severe maternal morbidity (SMM) in Maryland and nationally. Currently, through a quality collaborative, the state is implementing the Alliance for Innovation on Maternal Health (AIM) patient safety bundle on obstetric hemorrhage.
To describe SMM events contributed by obstetric hemorrhage and their preventability in Maryland.
This cross-sectional study used data from hospital-based SMM surveillance and review program in Maryland. Hospital-based SMM criteria include admission to an intensive care unit and/or transfusion of 4 or more units of blood products (of any type) during pregnancy or within 42 days postpartum. A total of 193 obstetric hemorrhage events that met the surveillance definition were identified in hospitals participating in SMM surveillance since inception on August 1, 2020 until December 31, 2022. We compared patient and delivery characteristics, practices done well, and recommendations for care improvement among patients with severe obstetric hemorrhage deemed preventable and non-preventable by hospital-based review committees. For obstetric hemorrhage events deemed preventable, we further identified factors that contributed to the SMM outcome at the provider, system, and patient levels.
Uterine atony was the leading cause of obstetric hemorrhage events (37.8%), followed by uterine rupture, laceration and intra-abdominal bleeding (23.8%). Sixty-six (34.2%) obstetric hemorrhage events were preventable. Patients with preventable obstetric hemorrhage were significantly more likely to have an emergency than planned cesarean delivery and less likely to have a placental complication or >1500 mL blood loss volume. Hospital-based review committees determined that 81.8%, 30.3%, and 22.7% of preventable events could have been prevented or made less severe through changes to provider, system, or patient factors, respectively. Recommendations following event reviews aligned with the Alliance for Innovation on Maternal Health Obstetric Hemorrhage Patient Safety Bundle, particularly regarding elements in the Recognition and Prevention and Response domains.
About one-third of SMM events contributed by obstetric hemorrhages were deemed preventable. Of AIM bundle elements, assessing hemorrhage risk on admission to labor and delivery, peripartum, and upon transition to postpartum care together with rapid, unit-standardized management of hemorrhage are likely to benefit more than half of patients with preventable SMM contributed by obstetric hemorrhage.
产科出血是马里兰州及全美孕产妇死亡和严重孕产妇发病（SMM）的主要原因。目前，该州正在通过一项质量协作项目，实施孕产妇健康创新联盟（AIM）针对产科出血的患者安全综合措施。
描述马里兰州产科出血导致的严重孕产妇发病事件及其可预防性。
这项横断面研究使用了马里兰州基于医院的严重孕产妇发病监测与审查项目的数据。基于医院的严重孕产妇发病标准包括在孕期或产后42天内入住重症监护病房和/或输注4个或更多单位（任何类型）的血液制品。自2020年8月1日启动至2022年12月31日，在参与严重孕产妇发病监测的医院中，共识别出193例符合监测定义的产科出血事件。我们比较了经医院审查委员会判定为可预防和不可预防的严重产科出血患者的患者及分娩特征、做得好的做法以及护理改进建议。对于判定为可预防的产科出血事件，我们进一步确定了在医疗服务提供者、系统和患者层面导致严重孕产妇发病结局的因素。
宫缩乏力是产科出血事件的主要原因（37.8%），其次是子宫破裂、撕裂伤和腹腔内出血（23.8%）。66例（34.2%）产科出血事件是可预防的。可预防的产科出血患者进行急诊剖宫产而非计划剖宫产的可能性显著更高，发生胎盘并发症或失血超过1500毫升的可能性更低。医院审查委员会确定，分别通过改变医疗服务提供者、系统或患者因素，81.8%、30.3%和22.7%的可预防事件本可避免或减轻严重程度。事件审查后的建议与孕产妇健康创新联盟产科出血患者安全综合措施一致，特别是在识别与预防及应对领域的要素方面。
约三分之一由产科出血导致的严重孕产妇发病事件被判定为可预防。在孕产妇健康创新联盟综合措施的要素中，在入院待产、围产期以及转入产后护理时评估出血风险，以及对出血进行快速、单位标准化管理，可能会使超过一半由产科出血导致的可预防严重孕产妇发病患者受益。
