Abstract
Objective The objective of this study was to compare severe morbidity due to obstetrical hemorrhage
and its potential preventability before and after a mandated provider training initiative
on obstetric hemorrhage.
Study Design Cases of severe morbidity due to obstetric hemorrhage during 2006 (n = 64 before training initiative) and 2010 (n = 71 after training initiative) were identified by a two-factor scoring system of
intensive care unit admission and/or transfusion of ≥ 3 units of blood products and
reviewed by an expert panel. Preventable factors were categorized as provider, system,
and/or patient related.
Results Potential preventability did not differ between 2006 and 2010, p = 0.19. Provider factors remained the most common preventable factor (88.2% in 2006
vs. 97.4% in 2010, p = 0.18), but the distribution in types of preventable factors improved over time
for delay or failure in assessment (20.6 vs. 0%, p < 0.01) and delay or inappropriate treatment (76.5 vs. 39.5%, p < 0.01). System factors also differed (32.4 vs. 7.9%, p = 0.015) with a notable decline in factors related to policies and procedures (26.5
vs. 2.6%, p < 0.01) between 2006 and 2010.
Conclusion We found significant improvement in provider assessment and treatment of obstetric
hemorrhage and a significant reduction in preventable factors related to policies
and procedures after the training initiative.
Keywords
hemorrhage - maternal morbidity - provider training - provider education
