Efficacy of Multidisciplinary Clinical Pathway for the Management of Postpartum Hemorrhage

A Mi Kim; Sang Jun Kim; Yoon Ha Kim; Jong Woon Kim; Hyun Ah Chung; Kyung Hwa Han; Han Bich Choi

doi:10.14734/PN.2019.30.4.214

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Kim, Kim, Kim, Kim, Chung, Han, and Choi: Efficacy of Multidisciplinary Clinical Pathway for the Management of Postpartum Hemorrhage

Original Article

Perinatology 2019; 30(4): 214-220.

Published online: 31 December 2019

DOI: https://doi.org/10.14734/PN.2019.30.4.214

Efficacy of Multidisciplinary Clinical Pathway for the Management of Postpartum Hemorrhage

A Mi Kim, MD, Sang Jun Kim, MD, Yoon Ha Kim, MD, PhD, Jong Woon Kim, MD, PhD, Hyun Ah Chung, MD, Kyung Hwa Han, MD, Han Bich Choi, MD

Department of Obstetrics and Gynecology, Chonnam National University Medical School, Gwangju, Korea.

Correspondence to Yoon Ha Kim, MD, PhD. Department of Obstetrics and Gynecology, Chonnam National University Medical School, 160 Baekseo-ro, Dong-Gu, Gwangju 61469, Korea. Tel: +82-62-220-6376, Fax: +82-62-227-1637, kimyh@jnu.ac.kr

Received 16 December 2018 Revised 12 April 2019 Accepted 23 September 2019

The Korean Society of Perinatology

(open-access, http://creativecommons.org/licenses/by-nc/4.0/):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective

To evaluate the efficacy of the clinical pathway known as the best linkage for expeditious expert decision (BLEED) system that we newly developed for the effective management of postpartum bleeding.

Methods

This study was designed as a retrospective analysis. From January 2015 to May 2019, 155 patients who were treated for postpartum hemorrhage were included in our study. The non-BLEED group included 86 patients who admit with postpartum hemorrhage before the introduction of BLEED system, and the BLEED group included 69 patients who were applied with BLEED system. We compared the outcomes between two groups including duration of hospital stay and amount of transfusion.

Results

Duration of hospital stay was shorter in BLEED group than in non-BLEED group (4.0±1.9 vs. 4.7±2.7 days, P<0.05). Amount of red blood cell transfusion was less in BLEED group than in non-BLEED group (4.7±3.3 vs. 6.4±5.4 units, P<0.05). There were no difference in clinical characteristics, initial laboratory value, time to get a blood transfusion between the two groups. There were no difference between the two groups in terms of management techniques, such as uterotonics, intrauterine balloon tamponade, pelvic artery embolization and cesarean hysterectomy.

Conclusion

BLEED system can be helpful method for the management of patients with postpartum hemorrhage.

Keywords: Postpartum hemorrhage, Critical pathways

Figures and Tables

Fig. 1

Patient information check list. BP, blood pressure; BW, body weight; Ht, height; P/I, present illness; CS, caesarean section; VD, vaginal delivery; NPO, nothing by mouth; P/Hx, past history; PR, pulse rate; Hb, hemoglobin; ABO, ABO blood type.

Fig. 2

(A) Initial protocol when patient occurred. (B) Protocol when BLEED system activation after patient arrival. OB, obstetrics and gynecology; BLEED, best linkage for expeditious expert decision; IV, intra-venous; ER, emergency.

Fig. 3

(A) Before arrival check list. (B) Initial check list. BLEED, best linkage for expeditious expert decision; ANES, anesthesiology; RD, radiology; F, fellow; V/S, vital sign; U/O, urine output; AC, abdominal circumference; IV, intra-venous; ABG, arterial blood gas; OBGY, obstetrics and gynecology; US, ultrasonography; EKG, electrocardiography; CXR, chest x-ray.

Table 1

Dermographic and Clinical Characteristics

Values are presented as mean±standard deviation or number (%).

Abbreviations: BLEED, best linkage for expeditious expert decision; LGA, large for gestational age; PPH, postpartum hemorrhage; Hb, hemoglobin; Hct, hematocrit; PLT, platelet; PT, prothrombin time; INR, international normalized ratio; PTT, partial thromboplastin time; FDP, fibrin degradation product.

^*Use the decimal system.

Table 2

Comparison of Management and Outcomes between the Two Groups

Values are presented as number (%).

Abbreviation: BLEED, best linkage for expeditious expert decision.

^*Repair of vaginal laceration, manual removal of retained placenta.

Table 3

Comparison of Amount of Transfusion and Hospital Day between the Two Group

Values are presented as mean±standard deviation or number.

Abbreviations: BLEED, best linkage for expeditious expert decision; ICU, intensive care unit; RBC, red blood cell; FFP, fresh frozen plasma; CRYO, cryoprecipitate.

Table 4

Comparison of Management Course between the Two Groups

Values are presented as mean± standard deviation.

Abbreviations: BLEED, best linkage for expeditious expert decision; Rh-O, O-negative; RBCs, red blood cells; cath, central venous catheterization.

Table 5

Comparison of Daytime and Nighttime Difference to Embolization Duration between the Two Groups

Values are presented as mean±standard deviation.

Table 6

Comparison of Amount of Transfusion and Hospital Day between the Two Groups

Values are presented as mean±standard deviation or number.

Abbreviations: BLEED, best linkage for expeditious expert decision; RBC, red blood cell; FFP, fresh frozen plasma; CRYO, cryoprecipitate.

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