Implementation of Postpartum Hemorrage Emergency Care Using Bundle Approach at a Tertiary Care Hospital in Bangladesh

Background: Postpartum hemorrhage (PPH) is a leading cause of maternal mortality and morbidity globally, especially in low- and middle-income countries like Bangladesh. Despite advancements in maternal healthcare, PPH management remains challenging due to inadequate resources and infrastructure. The bundle approach, which involves implementing a set of evidence-based interventions simultaneously, has emerged as a promising strategy to enhance PPH management and reduce maternal mortality. Objective: This study aims to evaluate the implementation process of a PPH care bundle at a tertiary care hospital in Bangladesh, focusing on its effectiveness, challenges, and outcomes. Method: Implementation of PPH EmC care using bundle approach was done over a period of about 24 months from December 2021 to December 2023. To observe the efficacy of Bundle Approach, we compared the outcome of initial 6 months (December 2021 to may 2022) with last 6 months of implementation period (July 2023 to December 2023). Results: Post-implementation, there was a significant reduction in blood transfusion rates (decreased by 60%, p=0.0319) and the need for radical surgical interventions, such as hysterectomies (reduced from 27.27% to 11.5%, p=0.032). The use of tranexamic acid increased significantly (from 12.72% to 32.69%, p=0.041). Conclusion: The implementation of the PPH EmC care using Bundle Approach at the tertiary care hospital in Bangladesh resulted in significant improvements in the management of PPH, particularly in reducing blood transfusions and radical surgeries. Despite these improvements, challenges such as increased severity of PPH cases suggest the need for ongoing refinement of the bundle approach. Further research is needed to fully assess its impact and address remaining challenges.