www.elsevier.com/locate/semperi Available online at www.sciencedirect.com Postpartum hemorrhage: The role of the Maternal–Fetal Medicine specialist in enhancing quality and patient safety Kathleen M. Antony, MD n , and Gary A. Dildy III, MD Department of Obstetrics and Gynecology, Division of Maternal–Fetal Medicine, Baylor College of Medicine, 6651 Main St, 10th Floor, Houston, TX 77030 ARTICLE INFO Keywords: Maternal-Fetal Medicine Postpartum hemorrhage abstract Postpartum hemorrhage in excess of 1000 mL affects 2.9–4.3% of deliveries in North America and the prevalence is increasing (Calvert et al., 2012 1 ; Callaghan et al., 2010 2 ). Given the unpredictable nature of most postpartum hemorrhages, all obstetric providers must under- stand the initial steps in the assessment and management of this emergency. In this monograph we will review the potential role of the Maternal–Fetal Medicine (MFM) specialist in managing this acute obstetric emergency. MFMs are uniquely positioned to develop hospital protocols, advocate for investment in resources to optimize outcomes, and utilize novel educational models, such as simulation, to educate other providers on the recognition and management of this condition. MFMs can also aid in the antepartum diagnosis of abnormal placentation, which is an increasingly common risk factor for severe hemorrhage. & 2013 Elsevier Inc. All rights reserved. 1. Introduction Specialists in Maternal–Fetal Medicine (MFM) traditionally serve as antepartum consultants in high-risk pregnancies. However, the role of the MFM in caring for intrapartum complications is less clear. When emergencies arise, special- ists are often not immediately available for acute manage- ment, especially given that up to two-thirds of postpartum hemorrhage (PPH) cases occur in women without identifiable risk factors. 3 The aim of this review is to explore how MFM specialists can become engaged in the management of post- partum hemorrhage, a condition which affects nearly 1/20 women. 1,2 In this monograph we propose that the MFM provider is uniquely poised to ensure that all providers at his or her hospital are fluent and up-to-date in handling this condition; MFMs have the expertise to develop structured guidelines, protocols, and feedback mechanisms, the teach- ing experience to assist with educating providers, and the ability to ensure that all providers in his or her referral catchments are alerted to risk factors for severe postpartum hemorrhage. 2. Developing structures Part of the MFM specialist's role is as an advocate for the parturient. As many deliveries (and thereby PPH) occur in settings where a specialist is not immediately available, the MFM can be instrumental in developing structures to ensure patient safety; the MFM could create and implement post- partum hemorrhage protocols including the creation and maintenance of obstetrical hemorrhage carts with point-of- care tests and the organization of response teams. The MFM may also serve as a resource and expert for peer-review committees. In 2010 the Joint Commission on Accreditation of Health- care Organizations recommended the adoption of protocols to address maternal mortality and morbidity associated with postpartum hemorrhage. 4 Shortly thereafter, Shields et al. described in detail the creation and initiation of one such protocol and demonstrated an improvement in patient safety and a reduction in the utilization of blood products. 5 In this protocol, patients' status and interventions were grouped into one of four categories (Stage 0–3) with continuing blood 0146-0005/13/$ - see front matter & 2013 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1053/j.semperi.2013.04.004 n Corresponding author. E-mail address: antony@bcm.edu (K.M. Antony). S EMINARS IN P ERINATOLOGY 37 (2013) 246 – 256