Time To Hemorrhage Response After Implementation of Obstetric Hemorrhage Bundle.

Abstract

Objective To evaluate the time to uterotonic administration before and after the implementation of an obstetric hemorrhage bundle. Study Design This is a retrospective cohort study of deliveries at an urban tertiary care hospital before and after implementation of an obstetric hemorrhage bundle. Two groups were compared on time from delivery to first dose of postpartum uterotonic intervention. Secondary outcomes included total number of uterotonics, transfusion rates, and utilization of non-uterotonic hemorrhage interventions including uterine artery embolization and balloon tamponade. Results Of the 4,275 deliveries of live births included in this study, 1944 occurred pre-intervention and 2,331 occurred post-intervention. Mean time to oxytocin decreased from 12.2 minutes to 5.9 minutes after implementation of the bundle (p<0.01). Post-intervention deliveries received significantly more second line uterotonics when compared to pre-intervention deliveries (p<0.01). Conclusion Implementation of an obstetric hemorrhage bundle was associated with improved management as reflected in faster and increased delivery of uterotonic interventions for hemorrhage. Future studies should continue to explore the effect of hemorrhage bundle protocols on hemorrhage-related process measures.