Am J Perinatol 2019; 36(13): 1344-1350
DOI: 10.1055/s-0038-1676976
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The New York State Safe Motherhood Initiative: Early Impact of Obstetric Hemorrhage Bundle Implementation

Dena Goffman
1   Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
Cande V. Ananth
1   Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
2   Department of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, New York, New York
Adiel Fleischer
3   Department of Obstetrics and Gynecology, North Shore University Hospital, Manhasset, New York
4   Department of Obstetrics and Gynecology, Long Island Jewish Medical Center, New Hyde Park, New York
Mary D'Alton
1   Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
Jessica A. Lavery
1   Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
Richard Smiley
5   Department of Anesthesiology, College of Physicians and Surgeons, Columbia University, New York, New York
Kristin Zielinski
6   The American College of Obstetricians and Gynecologists (ACOG), District II, Albany, New York
Cynthia Chazotte
7   Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
for the Safe Motherhood Initiative Obstetric Hemorrhage Work Group › Author Affiliations
Funding The SMI was funded through a grant from Merck for Mothers, Inc., and was awarded to the American College of Obstetricians and Gynecologists District II, New York.
Further Information

Publication History

16 April 2018

23 November 2018

Publication Date:
04 January 2019 (online)


Objective To determine the effects of the Safe Motherhood Initiative's (SMI) obstetric hemorrhage bundle in New York State (NYS).

Study Design In 2013, the SMI convened interprofessional workgroups on hemorrhage, venous thromboembolism, and hypertension tasked with developing evidence-based care bundles. Participating hospitals submitted data measured before, during, and after implementation of the hemorrhage bundle: maternal mortality, intensive care unit (ICU) admission, cardiovascular collapse, hysterectomy, and transfusion of ≥4 units of red blood cells (RBCs). Data were analyzed for trends stratified by implementation status.

Results Of the 123 maternity hospitals in NYS, 117 participated, of which 113 submitted data. Of 250,719 births, transfusion of ≥4 units RBCs (1.8 per 1,000) and ICU admissions (1.1 per 1,000) were the most common morbidities. Four hemorrhage-related maternal deaths (1.6 per 100,000) and 10 cases of cardiovascular collapse requiring cardiopulmonary resuscitation (4.0 per 100,000) occurred. Hemorrhage morbidity did not change over the five quarters studied. Risks were similar across hospital level of care and implementation status.

Conclusion Statewide implementation of bundles is feasible with resources critical to success. The low hemorrhage-related maternal death rate makes changes in mortality risk difficult to detect over short time intervals. Long-term and timely data collection with individual expert case review will be required.

* Safe Motherhood Initiative Obstetric Hemorrhage Work Group is listed in Acknowledgment.

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