Research Paper on Preventing Maternal Deaths from Postpartum Hemorrhage Worldwide

Introduction

Every year, many women across the globe suffer life-threatening injuries and sometimes die during parturition because health care institutions and health professionals often ignore safety practices when attending to pregnant women. In many occasions, most of these women tend to experience postpartum hemorrhage, which is the loss of blood exceeding 500ml following virginal birth and 1,000ml following cesarean (Dahlke et al., 2015). It is a potentially fatal condition which occurs within 24 hours after a woman gives birth and may extend up to 12 weeks after delivery (Dahlke et al., 2015). Postpartum hemorrhage is also considered to be the leading cause of maternal mortality and morbidity in both the developed and the developing countries and is responsible for approximately one-quarter of all the birth-related deaths. Sacred Heart Hospital in Pensacola, Florida, is known to skip the safety practices during childbirth and is one of the health care institutions with the leading cases of postpartum hemorrhages in the United States (US Today, 2019). These safety practices are not complex procedures that require complicated technology. They are easy steps that are often recommended by medical experts because they can save women's lives. This study will examine the postpartum hemorrhage problem at Sacred Heart Hospital, identify guidelines that will address the problem and describe the plan for the implementation of the proposed solution.

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Current Situation

Although Sacred Health Hospital provides a postpartum care plan designed to support women from the moment they give birth, the healthcare institution still ranks near the top of the state in terms of childbirth complications and deaths. According to US Today (2019), the median rate for severe parturition-related incidences in the United States is about 1.4 percent, and that of the state of Florida is approximately 1.5 percent. However, the same research also indicates that the median rate for fatal childbirth complications at Sacred Heart Hospital is about 3.2 percent. This data is for the institution's roughly 14, 350 parturitions between 2014 and 2017 (US Today, 2019).

According to Hernandez et al. (2018), the two main causes of childbirth complications or death in the state of Florida are maternal hemorrhage and hypertension. Consequently, Sacred Heart Hospital has become proactive and aggressive in implementing guideline and practices that address solutions to these problems. The hospital also claims that it is the only health care institution in Florida that conducts more than 4000 parturitions in a period of one year without severe maternal morbidity (US Today, 2019). However, numbers do not reflect the high quality of maternal care Sacred Heart claims.

Naturally, many health care institutions like Sacred Heart Hospital tend to put the blame on mothers when childbirths go wrong, but in reality, many of these complications and deaths are entirely preventable. The majority that occur are often times associated with denial and delayed response from the health care professionals (Hernandez et al., 2018). Most of the medical workers usually rely on their instincts and visual estimates to determine what should be considered too much blood loss. Additionally, some of the attendants lack adequate skills when it comes to delivering babies or providing minimum care. As a result, mothers are left helpless, bleeding until their organs shut down. They succumb to preventable blood clots and untreated infections.

Proposed Solution

Postpartum hemorrhage is a complex condition, and Sacred Heart Hospital only does the bare minimum to prevent and manage complications or deaths. The problem is that the institution relies majorly on the etiology and severity of the condition to select treatments which should not be the case. According to AbdulKadir et al. (2014), the treatment of postpartum hemorrhages must also be based on factors related to the setting of care, the availability of trained personnel, the standards of care in a given health care institution, and the availability of medications, and other therapeutic options. Based on the problems identified, Sacred Heart Hospital should actively manage the third party stage of labor. Health care institutions that have adopted this strategy in the past have benefited from a significant reduction in the incidence of massive hemorrhage. This procedure usually involves administering a uterotonic medication during birth or after the delivery of the anterior shoulder (Childress, Holloran-Schwartz, Wuebker, Gavard, & Blaskiewicz, 2014). Secondly, the health care institution need to use hypertension in pregnancy toolkit, which is often used to monitor blood pressure and blood loss. Additionally, Sacred Heart needs to ensure that postpartum hemorrhage carts are constantly available in its labor and delivery unit and postpartum wards so that blood loss can be prevented. The hospital also requires recurring nurse and physician education on various conditions relating to postpartum hemorrhage, its diagnosis as well as its management in a clinical setting. Finally, the institution needs to implement an annual multidisciplinary simulation of hemorrhage and hypertensive emergencies. This is because the best management strategy for postpartum hemorrhage often requires collaboration and strong teamwork (Lutgendorf et al., 2017).

If the proposed solutions is successfully implemented, it will result into a significant reduction of postpartum hemorrhage incidences. In particular, the change will decrease the current incidences by almost 70 percent (US Today, 2019). The proposed solution will also save the institution up to $100,000 annually on delayed discharges and another $92, 000 on complication costs (US Today, 2019).

Implementation

Four key components support effective implementation of new strategies for postpartum hemorrhage prevention and management at Sacred Heart Hospital. All these four steps must be carried out in order for the institution to be able to execute the strategies as planned. To begin with, before childbirth, there needs to be readiness by every unit. This will require medical workers to avail hemorrhage carts with medications and other equipment and supplies needed during deliveries. Also, in this step, there needs to be a response team that can be called in whenever there is a complication. The medical workers also need to establish emergency release transfusion protocols as well as unit education on protocols (Butwick & Goodnough, 2015). Secondly, there need to be a response for every hemorrhage during parturition irrespective of the amount of blood loss. Here Sacred Heart can institute an emergency management plan with checklists for the entire hospital, and also develop additional support program specifically for families, patients, and personnel.

The third step in this process is the recognition and prevention efforts for all the expectant mothers in the hospital. This phase requires antenatal assessment and intrapartum management. For antenatal assessment, health care professional at Sacred Heart needs to conduct screening and treatment for anemia antenatally (Dowswell et al., 2015). The screening should also be done for sickle cell disease for all the women who are due to deliver in the hospital. Also, parturition should only be carried out in facilities with sufficient blood banks and other in-house surgical services, whether the woman has a high risk of hemorrhage or not. Sonograms should also be obtained for women who indicate a higher risk of invasive placenta. Similarly, for intrapartum management, the medical personnel need to restrain from routine episiotomy and instrumental deliveries (Scott, 2014). They are, however, encouraged to use warm perineal compresses and routine management of the third stage of labor in every parturition.

Finally, Sacred Heart needs to have reporting and systems learning for every unit in the hospital. For example, the institution should always have debriefs after important procedures, a multidisciplinary review for system issues, and form a committee solely for perinatal quality improvement.

Evaluation

The expected outcome in this plan is the reduction of morbidity and mortality from postpartum hemorrhage at Sacred Heart Hospital. At the institution, this is usually caused by a lack of adequate equipment for deliveries, lack of adequate skills from the personnel, and sometimes due to negligence from medical personnel. A significant reduction of serious safety events at the institution can successfully be achieved by factors related to the setting of care, providing education for untrained personnel, improving the standards of care at the health care institution, and availing medications, and other therapeutic options during childbirth.

Return on Investment

Return on Investment usually calculates how much money businesses get back from the initial investment. A positive Return on Investment means that the amount returned exceeds the invested amount, and is usually considered desirable. In the health care setting, however, the outcome may be in terms of positive internal return arising from lower costs (Masters, Anwar, Collins, Cookson, & Capewell, 2017). At Sacred Heart, delayed discharges and high income usually costs the institution up to $100,000 annually (US Today, 2019), especially since the care has a fixed reimbursement regardless of days of stay. Additionally, complications cost the institution up to $92,000 annually (US Today, 2019). Since the new plan will lead to early discharge, reduced cost of complications and less equipment waste, it will save the institution up to 192,000 in a year.

Return on Investment = (Current value of investment- Cost of investment)/Cost of investment

= ($650,176- $458,176) / $458,176

= 0.4191

This project will break even in a period of one year and half.

Conclusion

Sacred Heart Hospital in Pensacola, is one of the health care institutions with the leading causes of postpartum hemorrhages in the United States. The problem is that the institution relies majorly on the etiology and severity of the condition to select treatments. However, the treatments should be based on factors related to the setting of care, the availability of trained personnel, the standards of care in a given health care institution, and the availability of medications, and other therapeutic options. The expected outcome of the proposed solution is the reduction of morbidity and mortality from postpartum hemorrhage. The new plan indicates a positive Return on Investment of 0.4191.

References

AbdulKadir, R., McLintock, C., Ducloy, A. S., ElRefaey, H., England, A., Federici, A. B., ... & James, A. H. (2014). Evaluation and management of postpartum hemorrhage: consensus from an international expert panel. Transfusion, 54(7), 1756-1768. Available at https://onlinelibrary.wiley.com/doi/abs/10.1111/trf.12550

Butwick, A. J., & Goodnough, L. T. (2015). Transfusion and coagulation management in major obstetric hemorrhage. Current Opinion in Anaesthesiology, 28(3), 275. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4567035/

Childress, K. M., Holloran-Schwartz, M. B., Wuebker, H., Gavard, J., & Blaskiewicz, R. (2014). The third stage of labor: A study of outcomes in the second trimester of pregnancy. The Journal of Reproductive Medicine, 59(7-8), 348-354. Available at https://europepmc.org/abstract/med/25098024

Dahlke, J. D., Mendez-Figueroa, H., Maggio, L., Hauspurg, A. K., Sperling, J. D., Chauhan, S. P., & Rouse, D. J. (2015). Prevention and management of postpartum hemorrhage: a comparison of 4 national guidelines. American Journal of Obstetrics and Gynecology, 213(1), 76-e1. A...