Postpartum Hemorrhage

Postpartum hemorrhage (PPH) — or excessive bleeding following childbirth — is the leading cause of maternal morbidity and mortality worldwide. It causes a dangerous drop in blood pressure that can result in organ failure or, in extreme cases, death.

PPH is preventable and treatable. The AHA is committed to driving improvement in maternal and child health and has highlighted important facts, resources and examples of how hospitals are strengthening their efforts to prevent, detect and manage PPH to improve maternal outcomes.

Causes and Effects of Postpartum Hemorrhage

Actionable Solutions for Hospitals and Health Systems

Consistent protocols and timely interventions are essential in reducing the risk and severity of postpartum hemorrhage. Recommendations from the field include:

Prepare

• Implement obstetric hemorrhage patient safety bundles, such as the AIM Patient Safety Bundle: Obstetric Hemorrhage.
• Have a hemorrhage cart with equipment and medications readily available.

Ochsner Health implemented the AIM obstetric hemorrhage patient safety bundle to systematically identify women with high risk of PPH and establish standard treatment, management, assessment and communication protocols. Ochsner also established a simulation center to provide hands-on training and simulated clinical scenarios to reinforce skills and improve teamwork and communication in managing PPH.

Titus Regional Medical Center administers vitals and bleeding assessments every 15 minutes in the first two hours post-delivery. The hospital’s trained care team prepares a hemorrhage cart, performs stimulations and partners with the pharmacy to easily access medication and time-efficient resources to quantify blood loss. The hospital also introduced the JADA hemorrhage device to control bleeding sooner and prevent the need for large blood product volumes. These efforts have increased protocol compliance rates and decreased hemorrhage, blood transfusions and readmission rates.

Train

• Train care team members to actively manage the third stage of labor, detect any risks and provide timely intervention.
• Establish an OB response team to call upon in an emergency.

The Children’s Hospital of San Antonio CHRISTUS Health uses Practicing for Patients, an obstetrics simulation program, to identify, treat and manage expectant mothers who experience hypertensive emergency or postpartum hemorrhage.

Measure

• Conduct PPH risk assessments during prenatal visits and at the onset of labor and integrate into electronic health records (EHR). The risk assessment should be updated throughout labor if risks change (e.g. prolonged labor).
• Implement a process for measuring quantitative blood loss (QBL) and document through a QBL calculator in the EHR to detect excessive bleeding.

WakeMed uses four tools to monitor and record blood loss effectively: the Association of Women’s Health, Obstetric and Neonatal Nurses postpartum risk assessment tool, a maternal emergency narrator, visual warning signs and a quantitative blood loss calculator in the EHR. These tools have been successful in decreasing postpartum hemorrhage rates since 2021.

Support

• Educate patients and family members about warning signs of PPH and be responsive to their concerns.
• Provide resources for the medical or psychological impact of PPH.

Columbus Regional Healthcare System, in collaboration with PPH survivors, developed an educational tool to better support women and their families after hospital discharge. This resource provides clear guidance on physical and emotional recovery, highlights warning signs that require medical attention, and allows patients to request more information on specific topics. It is designed to supplement existing discharge materials or be used during postpartum visits.

Resources from the Field

• AHA’s Better Health for Mothers and Babies Initiative
• Epic Collaboration: Strategies for Improving Postpartum Hemorrhage Outcomes Toolkit and Collaborative
• AIM Patient Safey Bundle: Obstetric Hemorrhage
• ACOG Clinical Guidance: Quantitative Blood Loss in Obstetric Hemorrhage
• AWHONN: Postpartum Hemorrhage and Risk Assessment Tools
• California Maternal Quality Care Collaborative: Improving Health Care Response to Obstetric Hemorrhage Toolkit, Version 3.0
• IHI: Obstetric Hemorrhage Change Package