Glantz J Christopher, Roy Amanda L, Bernstein Peter S, Goffman Dena, D'Alton Mary E, Lawless Kristen, Kacica Marilyn A
Department of Obstetrics and Gynecology University of Rochester School of Medicine Rochester New York USA.
Division of Family Health New York State Department of Health Albany New York USA.
Pregnancy (Hoboken). 2025 Jul;1(4):e70046. doi: 10.1002/pmf2.70046. Epub 2025 Jun 8.
Obstetric hemorrhage is one of the leading causes of maternal death and also one of the most preventable. In 2017, a New York statewide initiative led by the New York State Perinatal Quality Collaborative asked birthing hospitals to implement an ACOG District II Safe Motherhood Initiative evidence-based bundle on recognition and management of hemorrhage, and to assist and offer extensive education, assistance, and feedback. This report describes the process and results.
The bundle was available to all birthing hospitals. Hospitals were asked to implement 21 measures, with a goal of each measure being implemented by at least 85% of hospitals. Webinars and teaching sessions were attended by participating hospital teams to foster collaborative learning, share best practices, provide technical assistance and education, and serve as a forum for discussion of successes and barriers. Hospitals used standardized data collection forms to report measure implementation, aggregate patient data, and for major hemorrhages (requiring massive transfusion, hysterectomy, transfer to a higher level of care, or death), deidentified patient-level data. Data were analyzed using chi-square, repeated measures ANOVA, linear regression, and Cochrane's Q tests.
Eighty-six hospitals initially engaged (78 ultimately completed), with teams attending 35 webinars and 3 learning sessions. At the initiative's start, 6 of the 21 measures already were in place at 85% of hospitals; by the initiative's end, this increased to 19 of 21 with significant increases ( < 0.05) for all but two. The percent of patients defined as having obstetric hemorrhages increased during the initiative as use of quantitative blood loss (QBL) increased from 9.8% to 14.5% ( < 0.001); among patients with major hemorrhages, exclusive QBL use increased blood loss volume by 287 mL ( = 0.004). Among patients with major hemorrhages, the need for transfer to higher levels of care decreased during the initiative ( = 0.02), although rates of hysterectomy or use of massive transfusion were unchanged.
A comprehensive statewide initiative encouraging hospitals to adopt an evidence-based bundle on obstetric hemorrhage was successful in that 19 of 21 measures were implemented by ≥85% of hospitals. Focused statewide initiatives can improve hospitals' ability to provide evidence-based obstetrical care.
产科出血是孕产妇死亡的主要原因之一，也是最可预防的原因之一。2017年，由纽约州围产期质量协作组织牵头的一项纽约州范围内的倡议要求分娩医院实施美国妇产科医师学会第二区安全孕产倡议中关于出血识别和管理的循证集束干预措施，并提供广泛的教育、协助和反馈。本报告描述了该过程及结果。
该集束干预措施面向所有分娩医院。要求医院实施21项措施，目标是每项措施至少85%的医院能够实施。参与的医院团队参加了网络研讨会和教学课程，以促进协作学习、分享最佳实践、提供技术援助和教育，并作为讨论成功经验和障碍的论坛。医院使用标准化的数据收集表来报告措施实施情况、汇总患者数据，对于严重出血（需要大量输血、子宫切除术、转至更高护理级别或死亡），报告去识别化的患者层面数据。使用卡方检验、重复测量方差分析、线性回归和 Cochr ane Q检验对数据进行分析。
86家医院最初参与（最终78家完成），各团队参加了35次网络研讨会和3次学习课程。在该倡议开始时，21项措施中有6项在85%的医院已经实施；到倡议结束时，这一数字增加到21项中的19项，除两项外所有措施均有显著增加（P<0.05）。在该倡议期间，随着定量失血（QBL）的使用从9.8%增加到14.5%（P<0.001），被定义为患有产科出血的患者百分比增加；在严重出血患者中，仅使用QBL使失血量增加了287mL（P=0.004）。在严重出血患者中，在该倡议期间转至更高护理级别的需求有所下降（P=0.02），尽管子宫切除术或大量输血的发生率没有变化。
一项鼓励医院采用产科出血循证集束干预措施的全面的全州范围倡议取得了成功，21项措施中有19项由≥85%的医院实施。有针对性的全州范围倡议可以提高医院提供循证产科护理的能力。
