Time to Hemorrhage Response After Implementation of Obstetric Hemorrhage Bundle

Abstract

Objective

This study aimed to evaluate the time to uterotonic administration before and after the implementation of an obstetric hemorrhage (OBH) bundle.

Study Design

This is a retrospective cohort study of deliveries at an urban tertiary care hospital before and after the implementation of an OBH bundle. Two groups were compared on time from delivery to the first dose of postpartum uterotonic intervention. Secondary outcomes included a total number of uterotonics, transfusion rates, and utilization of nonuterotonic hemorrhage interventions including uterine artery embolization and balloon tamponade.

Results

Of the 4,275 deliveries of live births included in this study, 1,944 occurred preintervention and 2,331 occurred postintervention. The mean time to oxytocin decreased from 12.2 to 5.9 minutes after implementation of the bundle (p < 0.01). Postintervention deliveries received significantly more second-line uterotonics when compared to preintervention deliveries (p < 0.01).

Conclusion

Implementation of an OBH bundle was associated with improved management as reflected in faster and increased delivery of uterotonic interventions for hemorrhage. Future studies should continue to explore the effect of hemorrhage bundle protocols on hemorrhage-related process measures.

Key Points

• Oxytocin was administered more rapidly with OBH bundle use.

• Oxytocin was administered more frequently with OBH bundle use.

• Methylergonovine was administered more frequently with OBH bundle use.

Keywords

obstetric hemorrhage - uterotonics - oxytocin - implementation science

Publication History

Received: 15 August 2024

Accepted: 14 March 2025

Accepted Manuscript online:
17 March 2025

Article published online:
17 April 2025

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