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Maternal Outcomes Associated With a Statewide Obstetric Hemorrhage Quality-Improvement Initiative.
Ellen E Winter1, Timothy Wen, Dena Goffman
1Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York; and the Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, San Diego, California.
Obstetrics and Gynecology
|May 14, 2026
Summary
The New York Safe Motherhood Initiative
Area of Science:
- Obstetrics and Gynecology
- Maternal Health
- Quality Improvement Science
Background:
- The New York State Safe Motherhood Initiative (SMI) implemented a quality-improvement bundle to manage obstetric hemorrhage.
- Postpartum hemorrhage (PPH) remains a significant maternal health concern requiring effective management strategies.
Purpose of the Study:
- To evaluate the impact of the SMI obstetric hemorrhage bundle on statewide PPH outcomes.
- To assess trends in PPH and associated adverse events before, during, and after bundle implementation.
Main Methods:
- Analysis of New York State Inpatient Database delivery hospitalizations (2007-2022).
- Repeated ecologic cross-sectional study examining PPH diagnoses and adverse outcomes (transfusion, severe maternal morbidity (SMM), disseminated intravascular coagulation (DIC), hysterectomy).
- Joinpoint regression and adjusted logistic regression models were used to analyze trends and associations.
Main Results:
- PPH diagnoses increased statewide from 2007 to 2022.
- Following bundle implementation, rates of transfusion, SMM, and DIC initially decreased but later increased.
- Hysterectomy rates significantly decreased continuously from 2013 to 2022.
- Adjusted models showed decreased odds of SMM from 2016-2022 compared to 2007.
Conclusions:
- The SMI obstetric hemorrhage bundle coincided with initial reductions in adverse outcomes for PPH.
- Sustained decreases in SMM, DIC, and transfusion occurred for 3-4 years post-implementation.
- Continuous decrease in hysterectomy suggests a lasting positive impact, potentially influenced by case mix and comorbidity adjustments.
