Quantification of Obstetric Hemorrhage

Practice Problem: The practice problem identified involved the inconsistent measurement of blood loss during the postpartum period due to the standard practice of estimating blood loss. Estimates are subjective measures that can have variable results based on interpretation and thus provide minimal meaningful data. PICOT: The question that guided this project was structured in the following PICOT format. In postpartum women (P), how does the implementation of quantitative blood loss measurements (I), compared to estimated blood loss measurement (C), affect the early identification of severe hemorrhage (O), during the recovery period (T)? Evidence: Obstetric hemorrhage is a preventable event that accounts for 11% of maternal deaths in the United States and 27% worldwide. The Centers for Disease Control and Prevention (CDC) have reported a significant increase in the incidence of postpartum hemorrhage from data available from 1993 to 2014. Based on the date range reported, the rate of postpartum hemorrhage that required intervention increased from 4.3 to 21.2 per 10,000 cases. Intervention: The intervention involved the implementation of a standardized methodology for the quantification of blood loss during the postpartum period and was supported by providing continuous education to staff, monitoring blood transfusions, and transfers to higher acuity of care. Outcome: There was an increase in the number of blood transfusions which can be attributed to the positive effect of implementing QBL measurements and the effective implementation of mitigation strategies. A decrease in transfers to higher acuity of care also demonstrated that early identification of clinical decline positively affected patient outcomes. Conclusion: The implementation of a standardized protocol for the quantification of blood loss versus the current practice that involves estimating blood loss can aid in the early identification of obstetric hemorrhage