Postpartum hemorrhage (PPH) is a serious, but rare condition, which can occur at any point up to 12 weeks postpartum. PPH is when a woman experiences excessive bleeding, more than 1000 cc or 4 cups of blood. For women and their families, understanding the risks and signs of postpartum hemorrhage is the first step in getting prompt treatment.
The Military Health System (MHS) is standardizing across the world, a program to identify mothers at risk, in order to deliver prompt treatment by ensuring supplies, medications, and equipment are available at every military treatment facility (MTF) that delivers babies. This program, the Postpartum Hemorrhage Bundle, uses components of national initiatives to decrease the rising complication rates for mothers during delivery and postpartum periods. The PPH bundle implementation has shown that standardization can improve outcomes for mothers and families.
The Defense Health Agency (DHA) with oversight of all the MTFs established guidelines or what is known as DHA Procedural Instruction (DHA-PI) 6025.35 with specific requirements for equipment, supplies, processes, and education. In support of DHA-PI 6025.35, educational resources and tools such as the PPH Signs and Symptoms Infographic, have been developed for both clinicians and patients.
Clinician Information & Access to Resources
The PPH bundle is based on the Alliance for Innovation on Maternal Health (AIM) to focus on the “4 Rs” of System-level Readiness, Recognition, Response, and Reporting. This standardization provides each MTF, and clinical team with consistent resources, education, and training to optimize response and decrease adverse outcomes of PPH.
The PPH bundle follows AIM’s guidance and contains standardized processes and procedures to enhance readiness and quality of care, established through eight component areas:
- Stage-based checklist
- Risk assessment
- Quantitative blood loss
- Massive transfusion protocol
- Obstetric emergency cart
- Postpartum oxytocin
- Education and training
- Simulation and drills
The following clinician resources are currently available to help MTFs implement PPH DHA-PI 6025.35 guidance:
- Standardized training slides on each PPH bundle component
- Evidence-informed journal articles and resources
- Drafts of MTF-specific protocol
- Patient education materials
PPH is one of the top causes of maternal morbidity and mortality worldwide. Prevention of PPH is not always possible, but clinical evidence shows that prompt assessment, recognition, and timely interventions improve outcomes.