(1153) Management of Postpartum Hemorrhage Bundle – Implentation of a Novel PPH Flowsheet

Objective:
Postpartum hemorrhage (PPH) remains the most common childbirth complication and leading cause of maternal death worldwide. Lifesaving response requires early recognition, standardized care, and rapid access to uterotonics and blood products. We implemented a quality improvement initiative focused on structured team response using a novel PPH management flowsheet and enhanced hemorrhage alert protocol.

Study Design:
A hybrid implementation-effectiveness evaluation using a retrospective-prospective database included patients delivering from Jan 8, 2024, onward. The PPH Management Flowsheet was introduced June 12, 2024, followed by an alert overhaul on Mar 17, 2025. This included automatic blood bank notification, hemorrhage cart deployment, and a cultural shift in response to the “hemorrhage response”. Interrupted time series analysis assessed hemorrhage, transfusion, and uterotonic use across three epochs:
Epoch 1 (1/8/24–6/11/24): baseline
Epoch 2 (6/12/24–3/16/25): flowsheet
Epoch 3 (3/17/25–4/30/25): alert overhaul

Results:
Among 4,328 deliveries, no differences were noted across epochs in demographics, delivery mode, or preexisting conditions. PPH and severe PPH rates remained high (15% and 7.4%, respectively), with no significant changes in hemorrhage or transfusion rates. Uterotonic use trended upward post-alert overhaul but was not statistically significant, Fig. 1. There was a statistically-significant upward trend in PPH alert usage over time (p=0.026). Multi-segmented regression analysis reveals that this is not likely attributable to a singular intervention, Fig. 2.

Conclusion:
Initial implementation suggests improved team recognition and responsiveness to PPH, evidenced by increased uterotonic use and alert activation. The intervention demonstrates progress toward a proactive, standardized hemorrhage response culture.