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Step forward: implementation and evaluation of STEPS program to optimize postpartum hemorrhage management in vaginal
Pei Zhang1, Yifan Fan1, Hui Song1
1School of Medicine, Nankai University, Tianjin, China (Zhang, Fan, Song, Geng, Cui, Jia and Chen); Tianjin Central Hospital of Gynecology Obstetrics, Tianjin, China (Zhang, Fan, Lv, Song, Geng, Ma, Cui, Jia and Chen); Tianjin Key Laboratory of Human Development and Reproductive Regulation, Tianjin, China (Zhang, Fan, Song, Geng, and Chen).
Background:
Postpartum hemorrhage (PPH) is a leading cause of maternal mortality worldwide, particularly in resource-limited settings. Enhancing maternal safety in relation to PPH requires optimizing care protocols, continuous monitoring, and timely interventions. However, integrating these methodologies into vaginal delivery practices remains underexplored.
Objective:
To assess the impact and sustainability of a recently implemented Strategies and Tools to Enhance Parturient Safety (STEPS) program on PPH management.
Methods:
This before-and-after study included women who delivered vaginally between January 2020 and November 2023. Clinical practices and PPH-related outcomes were compared for 2-year periods before and after STEPS implementation, initiated in January 2022. The program involved enhanced perinatal care bundles, interdisciplinary team training, and continuous monitoring using statistical process control (SPC) tools. The primary outcome was PPH incidence (≥500 mL blood loss within 24 hours).
Results:
During the 4-year observation period, 24,235 women underwent vaginal deliveries. The incidence of PPH was 11.1% (1,473/13272) before STEPS and 11.8% (1,293/10963) after STEPS (aRR, 1.09; 95% CI, 1.00-1.18; P=.042). Severe PPH rates remained unchanged (aRR, 1.09; 95% CI, 0.90-1.33; P=.391). However, the proportion requiring blood transfusion significantly decreased (aRR, 0.77; 95% CI, 0.61-0.98; P=.035). Compared to preintervention period, a higher proportion of women experiencing PPH were identified as being at elevated risk prior to delivery in the postintervention period (P<.001). Notably, blood transfusion rates (P=.047) and hospital stay durations for women with PPH (P<.001) significantly declined.
Conclusions:
The STEPS program effectively improved PPH management by enhancing risk identification, increasing targeted interventions, and reducing blood transfusion rates and hospital stays. These findings highlight the importance of a comprehensive approach that integrates risk assessment, monitoring, and tailored interventions for managing PPH in vaginal deliveries, particularly in resource-limited settings.
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