Stop­ping the bleed­ing

Calif. col­lab­o­ra­tive tar­gets ma­ter­nal hem­or­rhage

Modern Healthcare - - Physician Affairs - Linda Wil­son

While most qual­i­ty­im­prove­ment ef­forts in ob­stet­rics fo­cus on im­prov­ing out­comes for ba­bies, a statewide col­lab­o­ra­tive in Cal­i­for­nia con­cen­trates on moth­ers.

Launched in 2004, Cal­i­for­nia Ma­ter­nal Qual­ity Care Col­lab­o­ra­tive’s qual­i­ty­im­prove­ment projects in­clude an on­go­ing ef­fort to re­duce deaths and med­i­cal com­pli­ca­tions re­sult­ing from ma­ter­nal hem­or­rhage.

“There are some causes of ma­ter­nal mor­tal­ity that you can’t do much about, but hem­or­rhage has a high de­gree of pre­ventabil­ity,” says El­liott Main, chair­man of ob­stet­rics qual­ity and safety for Sut­ter Health and di­rec­tor of the Cal­i­for­nia Ma­ter­nal Qual­ity Care Col­lab­o­ra­tive, Stan­ford, Calif.

Hem­or­rhage oc­curs in about 5% of births, and about one out of ev­ery 10 of those cases is se­vere, Main says.

That’s why the Cal­i­for­nia col­lab­o­ra­tive cre­ated a com­pre­hen­sive, ev­i­dence-based process, which 30 hos­pi­tals through­out the state im­ple­mented in 2009. As of Septem­ber 2010, clin­i­cians had used the new pro­to­cols in 110,000 births.

The idea is to iden­tify hem­or­rhage early and treat it ag­gres­sively to pre­vent bad out­comes. To do so, clin­i­cians mea­sure the amount of blood a mother loses. They also monitor vi­tal signs, such as blood pres­sure.

When the first signs of hem­or­rhage ap­pear, clin­i­cians re­act quickly, us­ing a sys­tem­atic process, be­gin­ning with tar­geted med­i­ca­tions and other mea­sures. If nec­es­sary, they move on to blood trans­fu­sions, us­ing what Main de­scribes as “whole blood”—not the blood prod­ucts typ­i­cally stored in blood banks.

A com­pre­hen­sive tool kit and ed­u­ca­tional we­bi­nars are avail­able on­line at

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