Premium
Ambulance Transfer in Case of Postpartum Hemorrhage after Birth in Primary Midwifery Care in The Netherlands: A Prospective Cohort Study
Author(s) -
Stolp Ineke,
Smit Marrit,
Luxemburg Sanne,
Akker Thomas,
Waard Jan,
Roosmalen Jos,
Vos Rien
Publication year - 2015
Publication title -
birth
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.233
H-Index - 83
eISSN - 1523-536X
pISSN - 0730-7659
DOI - 10.1111/birt.12171
Subject(s) - medicine , prospective cohort study , obstetrics , glasgow coma scale , blood pressure , emergency medicine , cohort study , pediatrics , anesthesia , surgery
Background The objective of this prospective cohort study was to assess whether the 45‐minute prehospital limit for ambulance transfer is met in case of postpartum hemorrhage ( PPH ) after midwifery‐supervised home birth in The Netherlands and evaluate the process of ambulance transfer, maternal condition during transfer, and outcomes in relation to whether this limit was met. Methods Using ambulance report forms and medical charts, ambulance intervals, urgency coding, clinical condition (using the lowest Revised Trauma Score, [ RTS ]), and maternal outcomes were collected. From April 2008 to April 2010, midwives reported 72 cases of PPH . Associations between duration of the ambulance transfer, maternal condition during ambulance transfer and outcomes were analyzed. The main outcome measures were duration of ambulance transfer, RTS , blood loss, surgical procedures, and blood transfusions. Results Seventy‐two cases were reported, 18 (25%) were excluded: 54 cases were analyzed. In 63 percent, the 45‐minute prehospital limit was met, 75.9 percent received a RTS of 12, indicating optimal Glasgow Coma Scale, systolic blood pressure, and respiratory frequency. In 24.1 percent a decrease in systolic blood pressure was found ( RTS 10 or 11). We found no difference in outcomes between women with different RTS or in whom the 45‐minute prehospital limit was or was not met. Conclusions We found no relation between the duration of ambulance transfer and maternal condition or outcomes. All women fully recovered. The low‐risk profile of women in primary care, well‐organized midwifery, and ambulance care in The Netherlands are likely to contribute to these findings.