Postpartum hemorrhage (PPH) is one of the leading causes of preventable pregnancy-related mortality. However, the risk of PPH can be estimated prior to its occurrence, which allows clinicians to take the necessary precautions to manage high-risk patients. This includes establishing two, 18-gauge (large-bore) intravenous (IV) catheters, an imperative first step in managing hemorrhaging patients. This retrospective study aims to assess how often obstetrical patients at high-risk for PPH received appropriate IV access, defined as two 18-gauge or larger IVs.METHODS:
A retrospective analysis of 922 obstetrical patients admitted to our institution over a 6-month period was performed. A patient's risk for PPH was determined on admission. Patients were stratified into low, medium and high-risk groups. The number and size of IV catheters inserted upon admission were reviewed.RESULTS:
Of the 922 patients analyzed, 10% (93) were deemed high-risk for PPH. Of those patients, 93.5% (87) received a single IV catheter on admission, of which 75% were 20-gauge or smaller IVs. Only 1% (1) of the high-risk patients received appropriate IV access (two 18-gauge or larger IVs).CONCLUSION:
Only 1% of patients at high-risk for PPH received appropriate IV access. Our data represents a single-center experience and should be confirmed. However, these results are concerning and suggest PPH patients may experience under-resuscitation and/or a delay in resuscitation due to inadequate IV access. Based on this data, the authors plan to revise the current Postpartum Hemorrhage Protocol and implement a new policy to ensure appropriate IV access is obtained in patients at high-risk for PPH.