OB Hemorrhage Definitions

Definitions, Early Recognition and Rapid Response Using Triggers

Kim Gregory, MD, Elliott Main, MD, Audrey Lyndon, RNC, PhD

Cedars-Sinai Medical Center; Department of OB/GYN, California Pacific Medical Center; University of California San Francisco School of Nursing

SUMMARY

Postpartum hemorrhage (PPH) is a leading cause of pregnancy-related mortality in developing and developed countries. Deaths due to PPH have declined in developed countries because hospitals have easier access to blood products, but PPH-related morbidities have remained constant and include massive transfusions, secondary surgical procedures, loss of fertility, and ICU admissions (1). The risk of hemorrhage is a mainstay of birth, but early identification creates the potential for intervention to prevent evolution into major hemorrhage. Early intervention requires 1) recognition of risk factors leading to heightened surveillance; 2) standardized approach to estimating blood loss; and 3) the use of clinical evaluative thresholds—typically vital signs—as triggers or alerts.

While efforts to standardize treatment abound, few have created a systematic PPH protocol for early recognition and early rapid response. This limit is due in part to of the broad range of clinical risk factors involved in PPH, lack of both standardized criteria for estimating blood loss (EBL) and a gold standard for defining PPH. This document focuses on providing a consensus definition of early or primary PPH occurring within the first 24 hours after delivery, which affects ~1-3% of pregnancies (2); and outlining clinical cues or triggers to identify and quickly respond to prevent a hemorrhage cascade.

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