Step forward: Implementation and evaluation of STEPS program to optimize postpartum hemorrhage management in vaginal deliveries.

IF 3.8 2区 医学 Q1 OBSTETRICS & GYNECOLOGY American Journal of Obstetrics & Gynecology Mfm Pub Date : 2024-12-13 DOI:10.1016/j.ajogmf.2024.101581
Pei Zhang, Yifan Fan, Hui Song, Yan Lv, Hao Geng, Pingchuan Ma, Hongyan Cui, Yanju Jia, Xu Chen
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Abstract

Background: Postpartum hemorrhage (PPH) is a leading cause of maternal mortality worldwide, particularly in resource-limited settings. Enhancing maternal safety in relation to PPH requires optimizing care protocols, continuous monitoring, and timely interventions. However, integrating these methodologies into vaginal delivery practices remains underexplored.

Objective: To assess the impact and sustainability of a recently implemented Strategies and Tools to Enhance Parturient Safety (STEPS) program on PPH management.

Methods: This before-and-after study included women who delivered vaginally between January 2020 and November 2023. Clinical practices and PPH-related outcomes were compared for two-year periods before and after STEPS implementation, initiated in January 2022. The program involved enhanced perinatal care bundles, interdisciplinary team training, and continuous monitoring using statistical process control (SPC) tools. The primary outcome was PPH incidence (≥500 mL blood loss within 24 hours).

Results: During the 4-year observation period, 24,235 women underwent vaginal deliveries. The incidence of PPH was 11.1% (1,473/13272) before STEPS and 11.8% (1,293/10963) after STEPS (aRR, 1.09; 95% CI, 1.00-1.18; p=0.042). Severe PPH rates remained unchanged (aRR, 1.09; 95% CI, 0.90-1.33; p=0.391). However, the proportion requiring blood transfusion significantly decreased (aRR, 0.77; 95% CI, 0.61-0.98; p=0.035). Compared to pre-intervention period, a higher proportion of women experiencing PPH were identified as being at elevated risk prior to delivery in the post-intervention period (p<0.001). Notably, blood transfusion rates (p=0.047) and hospital stay durations for women with PPH (p<0.001) significantly declined.

Conclusions: The STEPS program effectively improved PPH management by enhancing risk identification, increasing targeted interventions, and reducing blood transfusion rates and hospital stays. These findings highlight the importance of a comprehensive approach that integrates risk assessment, monitoring, and tailored interventions for managing PPH in vaginal deliveries, particularly in resource-limited settings.

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来源期刊
CiteScore
7.40
自引率
3.20%
发文量
254
审稿时长
40 days
期刊介绍: The American Journal of Obstetrics and Gynecology (AJOG) is a highly esteemed publication with two companion titles. One of these is the American Journal of Obstetrics and Gynecology Maternal-Fetal Medicine (AJOG MFM), which is dedicated to the latest research in the field of maternal-fetal medicine, specifically concerning high-risk pregnancies. The journal encompasses a wide range of topics, including: Maternal Complications: It addresses significant studies that have the potential to change clinical practice regarding complications faced by pregnant women. Fetal Complications: The journal covers prenatal diagnosis, ultrasound, and genetic issues related to the fetus, providing insights into the management and care of fetal health. Prenatal Care: It discusses the best practices in prenatal care to ensure the health and well-being of both the mother and the unborn child. Intrapartum Care: It provides guidance on the care provided during the childbirth process, which is critical for the safety of both mother and baby. Postpartum Issues: The journal also tackles issues that arise after childbirth, focusing on the postpartum period and its implications for maternal health. AJOG MFM serves as a reliable forum for peer-reviewed research, with a preference for randomized trials and meta-analyses. The goal is to equip researchers and clinicians with the most current information and evidence-based strategies to effectively manage high-risk pregnancies and to provide the best possible care for mothers and their unborn children.
期刊最新文献
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