Implementation of a postpartum hemorrhage algorithm after vaginal delivery with severe postpartum hemorrhage and influence on maternal outcome in the University Hospital Basel

Objective: Postpartum hemorrhage (PPH) is a leading cause of maternal mortality and morbidity and requires immediate medical care in terms of a standardized procedure. For this purpose, the “Handlungsalgorithmus PPH-Konsensus D-A-CH” was developed to rapidly initiate the required treatment. Analysis of the following case series evaluates its effectiveness (need for hysterectomy, necessity for further medical, surgical or mechanical interventions).

Methods: A retrospective case series was performed with a historical group (CG) (before introduction of the algorithm) and an intervention group after introduction (IG), collecting maternal and obstetric characteristics, and steps of the PPH algorithm.

Results: Out of 9199 deliveries, we included 234 with vaginal birth and blood loss of > 1000 ml of whom 58 represented the CG, 176 women the IG. Maternal and neonatal characteristics were not different. An increasing but not significant trend was found in the use of Sulprostone with 51% in the IG compared to 24% in the CG. A significant difference was found for Tranexamic acid with 62.7% treated in the CG and 86.9% in the IG with an average dose of 1.11 grams compared to 1.55 grams in the IG, P < 0.001. Regarding the interventions, ROTEM and application of Balloon tamponade increased not significantly. The initiation of each intervention occurred earlier and was documented more precisely.

Conclusions: Our retrospective case series acknowledges the PPH algorithm as useful guideline to manage PPH in a stepwise approach, with few waste of time and an improved documentation.