Expert care during childbirth saves mothers’ lives

Having a baby should be a joyous experience. However, complications can arise. Between two and five of every 100 women who give birth in the United States will experience a postpartum hemorrhage. Postpartum hemorrhage is defined as the loss of more than 500 milliliters (mL) of blood (about half a quart) during a vaginal delivery, and more than 1,000 mL of blood (a liter bottle of soda) during a caesarean delivery. Postpartum hemorrhage can be life-threatening, so a quick response and a well-trained team are essential to ensure a good outcome for the mother.

Postpartum hemorrhage has several potential causes, including vaginal lacerations, abnormal placenta attachment, and most commonly, the failure of the uterus to contract effectively after delivery.

Some examples of abnormal placenta attachment (placentation) include placenta previa, where the placenta is low-lying or covering the cervix, and placenta accreta, increta, or percreta, where the placenta attaches into the uterus more deeply than it should, or extends outside the uterus. In these cases, the risk for hemorrhage is increased because the placenta is growing through more layers of tissue than normal. A placental abruption occurs when the placenta detaches from the wall of the uterus before the baby is delivered; this can be life-threatening for the mother and the baby.

Once a baby is delivered, the mother’s uterus will continue to contract. These contractions assist in delivery of the placenta – called the third stage of labor – and after that, closing of the blood vessels that attached the placenta to the wall of the uterus. But if the uterus fails to contract effectively, called uterine atony, blood continues to flow freely, leading to postpartum hemorrhage.

At Beebe Healthcare, all moms are screened for risk factors when admitted to labor and delivery. These include a previous uterine surgery or caesarean section, obesity, and a history of previous postpartum hemorrhage; as well as complications such as preeclampsia or infection, having more than four previous births, carrying multiples, or having an overly distended uterus.

Beebe Healthcare, along with other hospitals across the country, is.taking steps to prevent and treat postpartum hemorrhage with great success. The Council on Patient Safety in Women’s Healthcare has developed a patient safety bundle, or set of standardized guidelines, that should be used to prepare for, identify, and treat postpartum hemorrhage. The guidelines are broken up into four sections: Readiness, Recognition, Response and Reporting.

Readiness – To ensure readiness, a hemorrhage cart, which contains everything needed to treat a hemorrhage all in one place, is always ready to deploy as soon as a hemorrhage is identified. Another step is to practice what to do during a hemorrhage using simulation training.

Recognition – All moms are screened upon admission, and again during their stay if appropriate, to identify their risk of hemorrhage. After delivery, blood loss is quantified, rather than visually estimated, so that as soon as a mom hits the identified limit, the team can initiate action steps to treat the hemorrhage. Pitocin is automatically administered during the third stage of labor (delivery of the placenta) to help the uterus continue to contract.

Response – Beebe has developed a standard protocol for treating obstetric hemorrhage, and has a special code, Code Crimson, which ensures that all appropriate personnel are available to treat this obstetric emergency.

Reporting – A perinatal dashboard allows Beebe to look at its own data and monitor incidences of obstetric hemorrhage with the goal of reducing them. It also participates in a statewide initiative to reduce maternal mortality and morbidity through the Delaware Perinatal Quality Collaborative, and conducts a formal review of all cases of severe hemorrhage.

Beebe has successfully used the four Rs to increase early identification and treatment of postpartum hemorrhage. Using the four Rs, which include employing best practices for prevention and treatment, Beebe Healthcare is becoming one of the safest places in the state for moms to deliver their babies.