We are now on a cusp: It’s time to stop talking about this future and begin building it.


We need to create a system that discusses risk factors and possible dangers and creates a plan of action accordingly—and PPH must be part of that discussion. If the potential for PPH becomes a normal part of the planning process, then if something goes wrong, the mother and her partner will have been presented with options well in advance. In addition, knowing the patient’s preference—for example, if they prefer a hysterectomy or would like UAE if viable—helps the health system plan for the birth, and allocate resources accordingly for an at-risk patient.


Improving data When a woman is at risk and there isn’t a quick trauma response, conducting a hysterectomy is the correct path. However, there are gray zones where UAE is a great choice—but OBs may not know about UAE or be willing to confidently identify when UAE may be the best choice.


As we have seen from the PERT model, a collaborative response team has allowed the community to share their data to improve patient outcomes. A PPH response team would do the same, creating more standardized data to create better evidence-based guidelines, so providers know how to respond when a woman is in a gray zone.


There is so much here to study: the path of physiology for a woman who has just given birth, or the causes of preeclampsia, hypertension or hypotension. We currently define our blood loss based on trauma data, but we don’t know if these parameters still apply to a woman who has had increased blood volume due to carrying a child. One of the benefits of a PPH team would be to collect data on blood loss to help future providers more effectively determine what stage of blood loss the mother is in—and thus make treatment decisions tailored to her specific situation. We don’t just need a response team. We need a data registry to help everyone at all stages of obstetrical trauma be better informed, make better plans and know when to call for help.


A future of maternal support As a society, we often underestimate the emotional and psychological trauma that happens from a situation like PPH, and we underestimate the impact on families and spouses. This trauma isn’t something that just effects babies and mothers. A patient’s partner is left to have the difficult discussions at the hospital, and if the worst happens, that partner becomes a single parent. Traumatic births have ripple effects throughout the entire family system.


VANGUARD


Boston Scientific Corporation Varian


SIR and SIR Foundation are grateful for the Corporate Ambassador Program (CAP) partner companies that invest in the specialty and help make our missions possible.


Medtronic LEADER


ADVOCATE AngioDynamics


BD Cook Medical Gore & Associates


ASSOCIATE


Abbott Vascular Argon Medical Devices Bristol-Myers Squibb


sirweb.org sirfoundation.org


Cordis, A Cardinal Health company Eisai, Inc. Galt Medical GI Supply, Inc.


Inari Medical Merck Pharmaceuticals Neuwave Medical Philips Healthcare Stryker IVS Tactile Medical


Terumo Interventional Systems


Guerbet Penumbra


Siemens Healthineers Sirtex Medical


We also cannot discount the impact of racial disparities on the health care process and the disproportionately high maternal death rate among the Black community. Combatting these systemic disparities require systemic solutions, and while PPH response teams may not solve the problems with access, they can improve the provider-patient relationship.


These problems cannot be solved in silos, and because hysterectomy is a known solution to PPH, we as doctors and researchers have taken our eyes off the prize. We must work together so that hysterectomy is not the only solution considered in the setting of postpartum hemorrhage. UAE offers a less invasive and irreversible alternative and mobilizing response teams and data registries are crucial in creating a future of safer, less traumatic deliveries. We are now on a cusp: It’s time to stop talking about this future and begin building it.


14 IRQ | SUMMER 2021


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