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Improving Outcomes in Obstetrical Hemorrhage by Implementing Multidisciplinary Team Management and a Delivery Planning Checklist.
Abstract Number: T-54
Abstract Type: Case Report/Case Series
Objective: Despite greater oversight, obstetrical hemorrhage provides multiple challenges to any Labor Unit with a high risk of morbidity and mortality including hysterectomy. We sought to review our experience after implementation of a multidisciplinary team based approach to management in cases identified at greatest risk of hemorrhage.
Materials and Methods: In cases identified at greatest risk of hemorrhage (previa and/or accreta) prior to admission to Labor and Delivery, a multidisciplinary team- based approach to managing/preventing hemorrhage was implemented to improve maternal outcome. The team included representation from anesthesia, nursing, obstetrics, gynecology oncology, interventional radiology, perfusion therapy, and blood bank. In addition, a pre-admission/intrapartum checklist was implemented to ensure communication and coordination of care among team members. Using hysterectomy as a marker for severe hemorrhage, we reviewed all cases of obstetrical hemorrhage resulting in cesarean hysterectomy from January 2009 to January 2012 before and after implementation of our team- based management protocol.
Results: Fourteen obstetric cases of cesarean hysterectomy were identified from January 1, 2009 to January 1, 2012. In six of the cases, management involved implementation of the multi-disciplinary team-based approach with a preadmission/intrapartum checklist coordinating care. There was no difference between the team-based management group vs the group without the team- based management in regards to age (37.3 +/_ 7.31 yo vs 34.4 +/- 5.86 yo; p=0.443); BMI ( 34.1 +/- 10.1 vs 33.2 +/- 7.2; p=0.875); OR time (411 +/- 45 min vs 606 +/- 200 min; p=0.398) or length of stay (5.3 +/- 1.5 days vs 5.9 +/- 1.6 days; p=0.554). Those patients managed utilizing the team-based approach had significantly lower blood loss (2283 +/- 580 ml vs 7643 +/- 2022 ml; p=0.037); less units of blood transfused ( 4.7 +/- 9.0 units vs 29.4 +/- 24.2 units; p=0.038) and shorter length of stay in the ICU (0.3 +/- 0.5 days vs 1.4 +/- 0.8 days; p=0.014).
Conclusion: A multidisciplinary team approach to managing patients at high risk for obstetrical hemorrhage utilizing a preadmission/intrapartum checklist should
be expected to improve pregnancy outcome.