Document Type

Dissertation

Degree

Doctor of Nursing Practice

Major

Nursing

Date of Defense

7-16-2025

Graduate Advisor

Charity Galgani, DNP, APRN, WHNP-BC

Committee

Annie Vining, DNP, WHNP-BC, RNC-MNN

Becky Boedeker, DNP, RNC-MNN, IBCLC, C-ONQS

Abstract

Problem: In the U.S., postpartum hemorrhage (PPH) is attributed to maternal morbidity and mortality, resulting in long-lasting effects of extended recoveries, surgical interventions, birth-related trauma, interruptions in mother-infant bonding, or death. Performing estimated blood loss (EBL) measurement methods postpartum is subjective and often associated with over- and underestimations of blood volume. The delay in recognition interferes with timely, efficient, and appropriate interventions, yielding a PPH (≥1000ml).

Methods: A quality improvement (QI) project was initiated with a descriptive, pre-implementation/post-implementation focus on a high-risk Labor and Delivery unit to explore the effects of Quantitative Blood Loss (QBL) measurements on the identification of PPH. A visual education tool was created and distributed to unit staff members to educate them on proper QBL technique post spontaneous vaginal delivery (SVD). A retrospective chart review was completed for all SVDs within the pre-implementation (Feb-Apr 2024) and post-implementation (Feb-Apr 2025) period while referencing the inclusion and exclusion criteria to formulate a convenience sample. The total blood loss (in milliliters), PPH rate, and EBL versus QBL utilization were collected and analyzed through retrospective chart reviews.

Results: A total of 156 women were included in the study. Of the total included, n=89 represented the pre-implementation period and n=67 represented the post-implementation period. The pre-implementation period reported that 48 participants (53.9%) had the EBL blood loss measurement method, and 41 (46.1%) had the QBL blood loss measurement method. A total of nine (10.1%) PPHs were identified; five utilizing EBL and four were identified utilizing QBL, demonstrating a statistical value of p 0.938 between groups. The post-implementation period reported 20 (29.9%) participants with EBL utilization and 47 (70.1%) participants with QBL utilization. Seven (10.4%) PPHs were identified; one utilizing EBL and six utilizing QBL, demonstrating a statistical value of p 0.238. Although not statistically significant, the PPH rate increased by 0.3% and displayed a clinical significance between the EBL compared to QBL groups during the pre- and post-implementation period. EBL utilization decreased by 24% and QBL utilization increased by 24% between pre- and post-implementation, exceeding the project's aim of 15%.

Implications: Implementation of QBL on a high-risk Labor and Delivery unit objectively measures blood loss and, in addition, creates a standardized approach to practice, eliminating the possibility of variance. Awareness of quantitative blood volume allows physicians and unit staff members to respond promptly with appropriate interventions, promoting early detection and efficiency. Further improvement projects should focus on the continued utilization of QBL and explore barriers to widespread implementation in practice.

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Additional Files

DNP CSP Poster 2025.pptx (528 kB)
DNP Poster

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