Resources for PQC Professionals

Estimation of blood loss is a primary cause of delayed action that could prevent poor outcomes related to hemorrhage. EBL has been found to underestimate blood loss by 33% to 50%, especially when substantial amounts of blood are lost. Severe maternal morbidity in Missouri has increased by 21% since 2016 (Hospital Industry Data Institute, 2023). The greatest marker for severe maternal morbidity was transfusion (Missouri Department of Health & Senior Services, 2023). Quantification of cumulative blood loss guides providers in appropriately managing obstetric hemorrhage to decrease incidence of morbidity and mortality (Main et al., 2015).

For more information visit the Obstetric Hemorrhage Initiative.

Universal screening is NOT biologic testing of urine or other bodily fluids. Universal screening is the use of a validated verbal screening tool to assess an individual’s risk for substance misuse and/or SUD. Universal screening provides an opportunity for providers to identify substance use as early as possible, conduct a brief intervention and refer the individual to services to support recovery and achieve positive maternal-infant outcomes.

Reference: American College of Obstetricians and Gynecologists Committee Opinion #711.

For more resources visit the Care for Pregnant and Postpartum People with Substance Use Disorder initiative.

Informed consent is required for biologic specimen collection except in cases where a warrant or court order exists. Failure to obtain informed consent for specimen collection is a violation of an individual’s Fourth Amendment right, which protects them from unreasonable searches and seizures.

Read the full Supreme Court ruling.

Read the full Perinatal Urine Drug Testing Guidance or visit the Care for Pregnant and Postpartum People with Substance Use Disorder initiative for more information.

Cerebral vascular changes during pregnancy affect blood vessel lumens. The pressure to dissect a vessel is much less; thus, the BP considered an emergency (increased risk for stroke) is lower during pregnancy than for the average adult. Any systolic BP ≥160 or diastolic BP ≥110 that persists for 15 minutes or more is considered a medical emergency in a pregnant or postpartum person and should be treated as soon as possible, but no longer than 60 minutes from the time of the original severe BP. A first-line antihypertensive medication such as IV Labetalol, IV Hydralazine or PO Nifedipine (immediate-release) should be initiated as part of a severe HTN in pregnancy treatment algorithm until the BP is no longer in the severe range. Ideally, antihypertensive medications and magnesium sulfate should be given concurrently. However, if this is not achievable, antihypertensive medications should take priority.

References: Hypertensive Disorders of Pregnancy PowerPoint, Recording and California Maternal Quality Care Collaborative Hypertensive Disorders of Pregnancy Toolkit

View additional resources on the Severe Hypertension in Pregnancy page.

Home blood pressure monitoring during pregnancy and the postpartum period helps improve early recognition of worsening BPs over time and severe range BPs allowing for timely initiation of antihypertensive medications or dose adjustments. Home monitoring programs result in fewer hospital readmissions. Additionally, these programs show promise of decreasing immediate complications and reducing the risk of long-term impacts on cardiovascular health (Corlin et al., 2023).

Download additional resources on the MHA Cuff Kit Project page and the Preeclampsia Foundation website.

The American College of Obstetricians and Gynecologists recommends screening for perinatal depression and anxiety at the initial prenatal visit, later in pregnancy and at postpartum visits. Because perinatal mental health conditions are common, the “Lifeline for Moms Perinatal Mental Health Toolkit” recommends screening for depression, bipolar disorder, anxiety and posttraumatic stress disorder at the initial prenatal visit and screening for depression, anxiety and PTSD in the second half of pregnancy and during postpartum visits.  For any response other than “never” on the self-harm question, further assessment of suicide risk is warranted. All pregnant and postpartum people should be screened for bipolar disorder prior to initiating an antidepressant because one in five birthing people who screen positive for depression could have bipolar disorder. Treating bipolar disorder with antidepressant medication increases the risk of mania, psychosis and suicide. Bipolar disorder is associated with an increased risk of postpartum psychosis, which is further associated with suicide and infanticide (Lifeline for Moms Perinatal Mental Health Toolkit).

Reference: Addressing Perinatal Mental Health Conditions in Obstetric Settings

Read more information on the Perinatal Mental Health Patient Safety Bundle page.

The American Academy of Pediatrics recommends mental health screenings be completed by pediatricians at well-child visits during the first year postpartum. Screenings should be completed within the first month and at two-, four- and six-month well-child visits to support the maternal-infant dyad. OB providers should be prepared to receive referrals from the pediatrician for postpartum people with a positive screen. Click the following links for more information.

References: Lifeline for Moms Perinatal Mental Health Toolkit and
Addressing Perinatal Mental Health Conditions in Obstetric Settings.

View more resources on the Perinatal Mental Health Patient Safety Bundle page.