How to build a team Collaboration A successful PPH response team will be large, requiring anesthesiologists, obstetricians, midwifes, nurses, IRs and their teams. But building this team requires collaboration. I believe that most OBs want partnership, because a PPH is one of the most frightening situations they face, and at the end of the day, they want to save their patient. However, there are misconceptions that IRs can’t activate fast enough, or don’t understand the severity of the clinical scenario. As IRs, we know that isn’t true—but there are ways to prove that a PPH team with IR at the lead can mobilize and be effective, such as putting on simulations of how these teams can work dynamically under stress.
Lexicon When I’m called and told there is a patient in trauma bay one, that’s all the information I need. That language alone activates the IR team and trauma surgeons, and an operating room is held open. We know the CT scanner will be available. The prep work is done and no one has to question the process, because everyone involved knows what will happen. This preparedness needs to be translated to obstetrical trauma.
I serve on the maternal mortality review committee at a tertiary inner- city hospital. We review morbidities and mortalities every month, and one case stuck out to me as the perfect example of why lexicon is key. A woman had a baby and hemorrhaged, and six doctors were trying to get her to the OR for a hysterectomy. At no point did anyone think to call an IR. When a nurse involved was discussing the urgency of the situation, she said, “It’s not like the patient was bleeding. She was bleeding.”
We don’t currently have a lexicon for how OBs or nurses can communicate with us to say a patient is bleeding. How do we objectify that? Trauma teams have code blues, and obstetrical response teams need to figure out their own equivalent so the parties involved do not have to rely on emotional enunciation to activate a multidisciplinary team that could
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save the life of the mother and reduce morbidity around this disease process.
The benefits of a PPH team Lessening trauma When women are preparing for a baby, they work with their health care provider to plan and check everything—they plan names and nurseries, prepare birthing plans, check their blood levels and glucose and run dozens of tests. But there is often no discussion about trauma. There isn’t often a conversation about what to do if things go wrong.
PPH is unannounced. It can happen to anyone, anywhere, at any time. Many patients don’t know they’re at risk until they are suffering a serious bleed. However, some risk factors can be identified in advance. The most predictive factor is that if a patient has had a PPH before, they are at high risk of having one again. There are other indicators that OBs watch for, such as tone and contractility in the uterus and coagulation. Abnormal placentation is another risk factor which has increased in recent years as more mothers plan cesareans, and there is the consideration of trauma during birth. Lacerations caused during delivery or abnormal bleeding disorders also increase risk of hemorrhage.
Uterine artery embolization (UAE) is a proven alternative to hysterectomy in many cases, and its minimally invasive nature can decrease the morbidities and costs associated with PPH, as well as preserve future fertility.
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