Reducing Hemorrhage-Related Maternal Morbidity Using Interdisciplinary Simulation Training

Postpartum hemorrhage (PPH) remains a major cause of preventable maternal morbidity in the United States. Postpartum hemorrhage simulations were developed to improve provider recognition and treatment; however, there exist few studies that investigate their effects on individual outcomes. Our objective is to estimate the effect of a simulation-based educational intervention on PPH-related maternal morbidity outcomes.

We conducted a retrospective cohort analysis of hemorrhage outcomes at a single institution between March 2012 and January 2016 during the implementation of a high-fidelity PPH simulation. Women with PPH defined as an estimated blood loss greater than 500 mL for vaginal delivery and 1000 mL for cesarean delivery were included. The primary outcome was a composite of hemorrhage-related maternal morbidity (maternal death, hysterectomy, intensive care unit admission, blood transfusion, or unanticipated procedures to treat postpartum bleeding). Multivariable logistic regression adjusted for confounding variables between presimulation and postsimulation outcomes.

During the study period, 19,927 deliveries occurred with 4.5% of patients (888) experiencing hemorrhage. Women in the presimulation (n = 278) versus postsimulation groups (n = 610) had similar demographics. Although the PPH rate increased after simulation [2.8% pre vs. 6.1% post, odds ratio (OR), 2.25; 95% confidence interval (CI), 1.95-2.60], composite hemorrhage-related morbidity was lower after simulation training (44% pre vs. 35% post; OR, 0.70; 95% CI, 0.52-0.93). This reduction persisted after adjusting for confounding variables of mode of delivery and time from delivery to first uterotonic use (adjusted OR, 0.66; 95%, CI 0.49-0.89).

Despite an increased PPH rate, simulation education was associated with a reduction in a hemorrhage-related maternal composite morbidity.