title: Preventing Maternal Morbidity from Obstetric Hemorrhage: Implications of a Provider Training Initiative.
abstract: ObjectiveThe objective of this study was to compare severe morbidity due to obstetrical hemorrhage and its potential preventability before and after a mandated provider training initiative on obstetric hemorrhage.Study DesignCases of severe morbidity due to obstetric hemorrhage during 2006 (n= 64 before training initiative) and 2010 (n= 71 after training initiative) were identified by a two-factor scoring system of intensive care unit admission and/or transfusion of ≥ 3 units of blood products and reviewed by an expert panel. Preventable factors were categorized as provider, system, and/or patient related.ResultsPotential preventability did not differ between 2006 and 2010,p= 0.19. Provider factors remained the most common preventable factor (88.2% in 2006 vs. 97.4% in 2010,p= 0.18), but the distribution in types of preventable factors improved over time for delay or failure in assessment (20.6 vs. 0%,p< 0.01) and delay or inappropriate treatment (76.5 vs. 39.5%,p< 0.01). System factors also differed (32.4 vs. 7.9%,p= 0.015) with a notable decline in factors related to policies and procedures (26.5 vs. 2.6%,p< 0.01) between 2006 and 2010.ConclusionWe found significant improvement in provider assessment and treatment of obstetric hemorrhage and a significant reduction in preventable factors related to policies and procedures after the training initiative.
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Illinois at Chicago, Chicago, Illinois.
authors.forename: Michelle A
authors.initials: MA
authors.lastname: Kominiarek
authors.affiliation: Department of Obstetrics and Gynecology, University of Illinois at Chicago, Chicago, Illinois.
authors.forename: Shirley
authors.initials: S
authors.lastname: Scott
authors.affiliation: Center for Research on Women and Gender, University of Illinois at Chicago, Chicago, Illinois.
authors.forename: Abigail R
authors.initials: AR
authors.lastname: Koch
authors.affiliation: Department of Obstetrics and Gynecology, University of Illinois at Chicago, Chicago, Illinois.
authors.forename: Maripat
authors.initials: M
authors.lastname: Zeschke
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Illinois at Chicago, Chicago, Illinois.
authors.forename: Yvette
authors.initials: Y
authors.lastname: Cordova
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Illinois at Chicago, Chicago, Illinois.
authors.forename: Samadh F
authors.initials: SF
authors.lastname: Ravangard
authors.affiliation: Advocate Lutheran General Hospital, Park Ridge, Illinois.
authors.forename: Deborah
authors.initials: D
authors.lastname: Schy
authors.affiliation: Department of Obstetrics and Gynecology, University of Illinois at Chicago, Chicago, Illinois.
authors.forename: Stacie E
authors.initials: SE
authors.lastname: Geller
mesh_terms: D000328:Adult; D001803:Blood Transfusion; D015331:Cohort Studies; D057210:Delayed Diagnosis / Q000517:prevention & control* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008428:Maternal Mortality; D009017:Morbidity; D006473:Postpartum Hemorrhage / Q000175:diagnosis / Q000628:therapy*; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000175:diagnosis / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D061665:Time-to-Treatment / Q000706:statistics & numerical data; D055815:Young Adult