Stanford PRIHSM: PReventing Inequities in Hemorrhage-related Severe Maternal Morbidity

Stanford University, Stanford CA

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Abstract

Overall Modified Project Summary/Abstract Section Postpartum hemorrhage (PPH) is a leading cause of maternal death and severe maternal morbidity (SMM) with disproportionate effects across a population. We propose to create a Maternal Health Research Center of Excellence at Stanford University called PRIHSM (PRomoting Improvement in Hemorrhage-related Severe Maternal morbidity). The goals of PRIHSM are to reduce PPH and associated SMM by addressing important precursors to PPH-related SMM and mortality: iron deficiency anemia (IDA) and obstetric care variability contributing to cesarean birth. The problem of maternal IDA is vastly under-appreciated yet it affects approximately 16% of pregnancies in the U.S. We propose that by effectively addressing antenatal IDA, we can reduce PPH-related SMM. Additionally, almost 1 in 3 U.S. births are by cesarean delivery and rates vary 10-fold across hospitals. While cesarean section can be a lifesaving intervention when appropriate, it is associated with significant risks that include PPH. We propose that addressing variability in obstetric care is an important strategy in reducing cesarean-linked PPH and reducing PPH-related SMM. Thus, our Aims are to: Aim 1 (Project 1). Reduce antenatal IDA by developing, implementing, and disseminating a patient-informed Anemia Prevention Toolkit, which will standardize the evaluation, diagnosis, and treatment of IDA and reduce the prevalence of IDA at birth admission and PPH-associated SMM. Aim 2 (Project 2). Reduce rates of primary cesarean birth and cesarean-linked PPH by conducting a mixed methods study to understand obstetric care-related drivers of hospital-level rates of these outcomes, and implementing a patient-informed Hospital Action Guide. Our work will involve community-university partnerships focused on improving maternal health and be driven by perspectives of patients, providers, and healthcare leadership. Our work will provide training opportunities to build research and clinical expertise relevant to PPH, including individuals who represent experiences within academic and community-based settings, and underserved areas. We propose a bold yet achievable agenda that will affect a sustainable decline in PPH-related mortality and morbidity.