This was a paper that I really enjoyed reviewing. It discusses the effect of applying a comprehensive protocol for managing maternal haemorrhage across a group of hospitals in New York State. All hospitals were required to have a dedicated perinatal safety nurse to collect data.

In New York State there is a rate of obstetric haemorrhage of about 3% of all deliveries and extradinarily abnormal placentation has overtaken uterine atony as the most common cause of obstetric haemorrhage. Over 32,000 deliveries were assessed in the before and after periods, and there was a significant reduction in blood product utilization and a non-significant reduction in puerperal hysterectomy.

This paper goes to show once again, as in other clinical scenarios, that implementation of a management protocol rather than allowing health professional judgement leads to improved clinical practice.

– Beverley J. Hunt

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