Early Elective Deliveries and Social Media Maternal Affinity Group April 24, 2013.
Maternal Affinity Group
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Maternal Affinity Group September 25, 2013
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Maternal Affinity Group. September 25, 2013. Objectives. Name at least 3 of the core elements of Postpartum Hemorrhage Identify the need for a risk factor Postpartum Hemorrhage admission assessment Understand the necessity of accurately assessing blood loss for Postpartum Hemorrhage. - PowerPoint PPT Presentation
Transcript of Maternal Affinity Group
Maternal Affinity GroupSeptember 25, 2013
Objectives• Name at least 3 of the core elements of Postpartum
Hemorrhage• Identify the need for a risk factor Postpartum Hemorrhage
admission assessment • Understand the necessity of accurately assessing blood loss
for Postpartum Hemorrhage
Why is this important?• Postpartum Hemorrhage occurs in about 18% of births• Common cause of maternal morbidity• massive transfusions• secondary surgical procedures • ICU admissions • fertility loss
Early Intervention is the KEY
Early intervention requires the following:• Recognition of risk factors leading to heightened surveillance; • Standardized approach to estimating blood loss; • The use of clinical triggers or alerts such as:• heart rate (>/= 110)• blood pressure (</= 85/45 or >15% drop)• oxygen saturation (<95%)
Core Elements• Develop a policy for PPH with the at least the following
components:• Definition of PPH for your institution• Risk Factors• Initial Interventions• Medical Treatments• Surgical Treatments• Defined Care Team and Role Clarity• Checklist Algorithm• Transfusion Policy• Drills
Obstetric Hemorrhage Key Element Checklist
Highest Priority:• Unit-standard OB Hemorrhage protocol• Hemorrhage Cart• Partnership with Blood Bank• Post-event debrief/huddle• Assessment of hemorrhage risk on admission• Assessment of cumulative blood loss
Hemorrhage Risk Assessment
Low (Clot Only) Medium (Type & Screen) High (Type & Crossmatch)No previous uterine incision Prior C/S or uterine surgery Placenta previa, low lying placentaSingleton pregnancy Multiple gestation suspected placenta accreta </= 4 previous vaginal births > 4 previous vaginal births Hematocrit < 30 AND other risk factorsNo known bleeding disorder Chorioamnionitis Platelets < 100,000No history of PPH History of PPH Active bleeding (greater than show) on admit
Large uterine fibroids Know coagulopathyEstimate fetal weight > 4kgMorbid obesity (BMI >35)
Hemorrhage Risk Factor Evaluation
Hemorrhage Cart
OB Hemorrhage Cart: Recommended Instruments (California Maternal Quality Care Collaborative - CMQCC)• Set of vaginal retractors (long right angle);• long weighted speculum• Sponge forceps (minimum: 2)• Sutures (for cervical laceration repair and B-Lynch • Vaginal Packs• Uterine balloon • Banjo curettes, several sizes• Long needle holder• Uterine forceps
Hemorrhage Medication Tray
As recommended by CMQCC• Pitocin 20 units per liter NS 1 bag• Hemabate 250 mcg/ml 1 ampule• Cytotec 200mg tablets 5 tabs• Methergine 0.2 mg/ml 1 ampule
Partnership with Blood Bank• Have a partnership with your blood bank for especially for PPH• Involve them in the protocols (even development of them)• Make sure they have what you need and can get it quickly• They also make for a great partner in data collection
Assessment of Blood Loss• Often blood loss in underestimated• Develop a standard in your hospital• Important to have training involving the estimation of blood
loss• >500 ml for vaginal birth • >1000 ml for cesarean birth may be the most common clinical
definition in the U.S
Estimating Blood Loss
Methods for quantifying blood loss:1. Percent saturation of blood soaked items with visual cues:
pictures, posters2. Weighing blood soaked pads/chux3. Collecting blood in graduated measurement container
Important to standardize methods in hospital that everyone understands and is trained to use!
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• British Journal of Anaesthesia;Hemostatic Monitoring During Postpartum Hemorrhage and Implications for Management;C. Solomon, R. E. Collis, P. W. Collins;DisclosuresBr J Anaesth. 2012;109(6):851-863
Post-Event• Important to debrief the event• Establish a culture of ALWAYS performing a huddle/debrief
using a tool:• CMQCC Debrief Form• Mini-RCA• IHI Trigger Tool
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References• http://mail.ny.acog.org/website/Optimizing_Hemorrhage/Sim
ulation_Drills.pdf
• http://mail.ny.acog.org/website/optimizing_hemorrhage/definition_early_recognition.pdf
• http://www.pqcnc.org/documents/fpqc/FPQCOHIHospitalImplementationGuide.pdf
• http://www.cmqcc.org/resources/ob_hemorrhage/protocols_guidelines
