Bundling Up Maternal Safety: Obstetric Hemorrhage

Summary and Comment |
July 16, 2015

Bundling Up Maternal Safety: Obstetric Hemorrhage

  1. Allison Bryant, MD, MPH

National Partnership for Maternal Safety releases first of many sets of evidence-based recommendations.

  1. Allison Bryant, MD, MPH

The focus of obstetric care has shifted from maternal mortality (a rare event) to prevention of severe maternal morbidity. The National Partnership for Maternal Safety, a collaboration of women's healthcare professional organizations, is developing “safety bundles” (defined by the Institute of Healthcare Improvement as small sets of evidence-based recommendations) for all maternity hospitals to adopt. The newly released first bundle concerns obstetric hemorrhage, a common complication of childbirth. The bundle's four domains are Readiness, Recognition and Prevention, Response, and Reporting and Systems Learning. Key elements include the following:


  • Immediate availability of hemorrhage medications and a cart with supplies and procedural mnemonic aids

  • Rigorous staff education in protocols for massive transfusion


  • Accurate estimation of obstetric blood loss

  • Active management of third stage of labor with emphasis on use of oxytocin


  • Standardized management plans for hemorrhage

Reporting and Systems Learning

  • Promotion of team huddles and event debriefings

  • Ongoing review and process improvement efforts


The Partnership hopes that all birthing hospitals will be able to assemble each element of the safety bundles. In particular, low-resource institutions can use these recommendations to guide decisions to transfer women at greater risk to hospitals capable of providing higher levels of care. I applaud these efforts to standardize preparedness across birthing centers. In particular, recognizing the need to empower team members to participate in huddles, debriefings, and case reviews is insightful. Still, this is probably easier said than done for many units, where the development of safety cultures is most challenging — but also of highest potential yield.

Editor Disclosures at Time of Publication

  • Disclosures for Allison Bryant, MD, MPH at time of publication Nothing to disclose


Reader Comments (1)

Mohamed Elsheikh Physician, Obstetrics/Gynecology, UAE


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