Introduction of a Novel System for Quantitating Blood Loss After Vaginal Delivery: A Retrospective Interrupted Time Series Analysis (Paper 1); Training for the Surgical Management of Postpartum Hemorrhage: A Four-State Survey of Resident Physicians in Mexico (Paper 2)

Abstract

Overview of the thesis papers. Postpartum hemorrhage (PPH) is a leading cause of severe maternal morbidity and preventable maternal mortality worldwide. Moreover, the rate of PPH is increasing in high-income countries including the United States (US). In the present document, we present the results of two patient-oriented research projects related to the measurement of cumulative blood loss and medical education on PPH protocols; both subjects are highlighted by the National Partnership for Maternal Safety (NPMS) obstetric hemorrhage bundle recommendations. The NPMS is a multidisciplinary task force endorsed by all obstetric subspecialty societies in the US. More timely detection of abnormal bleeding prompts earlier recognition and subsequent treatment of PPH. Therefore, systems that promptly identify PPH after delivery are warranted since there is an underestimation of blood loss (up to 50%) using visual estimation methods. In the first paper, we compared the PPH incidence and related outcomes before and after the introduction of a novel device for quantitation of blood loss (after vaginal delivery) that combines volumetric and gravimetric measurements. Approximately 15% of patients with PPH require surgical intervention; therefore proficiency in surgical techniques among all birth attendants is critically essential. The second paper is related to the obstetrics and gynecology (OBGYN) residents overall knowledge and proficiency in performing the most common surgical techniques to manage PPH. In addition to the primary aim mentioned above, we also describe education resources, barriers for training and the decision-making process for the surgical management of PPH. We collected this information via an electronic survey sent to the OBGYN residents of four public hospitals in Mexico.