Implementation of a multidisciplinary clinical pathway for the management of postpartum hemorrhage: A retrospective study

Abstract

Objective: To compare the outcomes of postpartum hemorrhage (PPH) episodes before and after the introduction of a clinical pathway known as the Severance Protocol to save postpartum bleeding through Expeditious care Delivery (SPEED). Design: This study was designed as a retrospective analysis. Setting: The study was conducted in a hospital implementing SPEED. Participants: The non-SPEED group included 74 patients with PPH who were treated before the introduction of SPEED, whereas the SPEED group included 155 patients. Methods: Differences in outcomes were compared between groups. Main Outcome Measures: Reduction in treatment duration was the primary outcome measure, whereas uterus preservation was the secondary. Results: No significant intergroup differences were observed for hemoglobin levels, hematocrit values and vital signs upon patients' emergency room arrival. The turnaround time for hemoglobin, mean duration until treatment by obstetricians and gynecologists and duration between chest radiography ordering and performance significantly differed between the two groups (SPEED, 10.0 [1.0-30.0], 3.0 [0-25.0] and 23.0 [1.0-86.0] min, respectively; non-SPEED, 17.0 [1.0-37.0], 12.0 [0-62.0] and 46.0 [1.0-580.0] min, respectively; P < 0.001). Similarly, the mean duration until transfusion of cross-matched red blood cells (SPEED, 77.6 ± 58.6 min; non-SPEED, 103.4 ± 64.4 min; P = 0.015) and uterus preservation rate (SPEED, 90.1% [136/151]; non-SPEED, 81.7% [58/71]; P = 0.043) also differed significantly between the groups. Conclusions: Clinical pathways enable prompt and efficient care for patients experiencing PPH through faster evaluation and access to red blood cell transfusion, resulting in a decrease in maternal mortality.