Approximately 700 women die each year in this country from pregnancy-related complications. The leading cause of these deaths is maternal or obstetric hemorrhaging — which experts describe as excessive blood loss from giving birth. (ACOG Practice Bulletin, Number 183 October 2017).
The American College of Obstetricians and Gynecologists (“ACOG”) defines maternal hemorrhaging as a cumulative blood loss of greater than or equal to 1,000 mL, or blood loss accompanied by signs or symptoms of hypovolemia, within 24 hours after the birth process. An abnormal uterine – a uterus that does not contract after giving birth – is estimated to cause 70%- 80% of maternal hemorrhage cases. (ACOG Practice Bulletin, Number 183 October 2017).
Episodes of severe maternal hemorrhaging resulting in death are far more prevalent among black women than any other group. Statistics show that black women are 2 to 6 more times likely to die from complications of pregnancy, such as maternal hemorrhaging, than non-Hispanic white women. (American Medical Association, 1999). Sadly, statistics also show that most maternal deaths resulting from maternal hemorrhaging were preventable. In a recent study that reviewed maternal deaths in North Carolina, the study found that 93% percent of maternal deaths in that state could have been prevented.
With the condition of maternal hemorrhaging killing mothers at an alarming rate in this country, mothers must be vigilant in seeking out care providers who are committed to following best practices that will increase the chances of either preventing, or effectively treating maternal hemorrhaging.
Recently, the Council on Patient Safety in Women’s Health Care (“Council”) established a set of safety bundles to address the issue of maternal hemorrhaging. According to the Institute of Healthcare improvement, safety bundles are “a structured way of improving the process of care and patient outcomes by using a small set of evidence-based practices that when preformed collectively and reliably, have been proven to improve patient outcomes.” Many of the Council’s safety bundles addressing maternal hemorrhaging derive from Practice Bulletins originally published by the American College of Obstetricians and Gynecologists
The Council’s safety bundles were written to help care providers establish plans and protocols that will allow providers to prevent and more effectively treat mothers suffering from maternal hemorrhaging. The specific bundles can be broken down into four categories: readiness, recognition, response and reporting.
Regarding readiness, the Council recommends that care providers possess:
- Hemorrhage carts with supplies, checklist, and instruction cards for intrauterine balloons and compressions stitches.
- Provide immediate access to hemorrhage medications (kit or equivalent).
- Establish a response team – who to call when help is needed (blood bank, advanced gynecologic surgery, other support and tertiary services).
- Establish massive and emergency release transfusion protocols (type-O negative/uncrossmatched).
- Provide Unit education on protocols, unit-based drills (with post-drill debriefs).
Regarding recognizing signs of maternal hemorrhaging, the Council recommends that providers establish:
- An assessment of hemorrhage risk on all prenatal patients before and after delivery.
- Measure cumulative blood loss (formal, as quantitative as possible).
- Actively manage the 3rd stage of a woman’s labor (department-wide protocol).
With respect to responding appropriately to women suffering from maternal hemorrhaging, the Council recommends that care providers establish a:
- Unit-standard, stage-based, obstetric hemorrhage emergency management plan with checklists.
- Support programs for patients, families, and staff for all significant hemorrhages.
Finally, regarding reporting women who have been diagnosed with maternal hemorrhaging, the Council recommends that care providers establish:
- A culture of huddles for high risk patients and post-event debriefs to identify successes and opportunities.
- Multidisciplinary review of serious hemorrhages for systems issues.
- Monitor outcomes and process metrics in perinatal quality improvement (QI) committee
As a mother during pregnancy, nothing should be left to chance regarding your health or the health of your unborn child. In deciding which health care provider care will serve as the right fit for you during your pregnancy, you should choose care providers that have already implemented the best practices referenced above to help prevent and effectively treat maternal hemorrhaging. Your life, literally, could depend upon this decision.
The Magna Law Firm represents individuals who have lost family members as the result of doctor negligence. If you or a loved one has lost a family member under these circumstances, please contact our law firm to schedule a free consultation with our attorney. We work on a contingency fee basis which means that we do not recover attorney fees unless we win your case.
