Effect of improved uterotonic availability on postpartum hemorrhage and maternal morbidity after vaginal delivery, review of a single-center quality-improvement initiative

Introduction

After implementation of a hemorrhage risk stratification system and management bundle in 2019, our hospital demonstrated a reduction in hemorrhage-related severe maternal morbidity (SMM-H). We then noted a plateau in postpartum hemorrhage (PPH) rates and a gradual increase in SMM-H after 2020, with the majority of PPH after vaginal deliveries (VDs) occurring in those deemed low-risk. Consequently, we implemented a strategy to improve the availability of second-line uterotonics in the delivery room regardless of PPH risk. The objective of this study is to evaluate the effect of this intervention on rates of PPH and SMM-H after VDs.