Presented September 3, 2025 at the 2025 APSF Stoelting Conference on “Transforming Maternal Care: Innovations and Collaborations to Reduce Morbidity and Mortality”
SUMMARY
Beth Clayton, DNP, CRNA, FAANA, FAAN’s presentation addresses the critical challenge of Maternal Hemorrhage (MH), a leading cause of maternal mortality and morbidity. The talk emphasizes that delayed diagnosis due to unreliable visual blood loss estimation is a major obstacle. While pharmacologic options like prophylactic Tranexamic Acid (TXA) have mixed evidence, system-level interventions using multidisciplinary care bundles, such as the California Maternal Quality Care Collaborative (CMQCC) guidelines, have been proven most effective in reducing severe maternal morbidity. Furthermore, the rising incidence of Placenta Accreta Spectrum (PAS) necessitates specialized care at tertiary centers with structured protocols and multidisciplinary teams to ensure optimal outcomes.
Key Points:
- Hemorrhage Detection
Visual blood loss estimation is inaccurate. Optimal early detection requires combining the use of calibrated collection drapes with clinical observation [02:43, 03:24]. Traditional markers like hemoglobin and shock index often serve as confirmation of deterioration rather than timely early recognition [04:19, 04:35]. - TXA Prophylaxis
Prophylactic Tranexamic Acid (TXA) is not recommended for low-risk patients (vaginal or Cesarean). It shows potential benefit only for high-risk Cesarean deliveries and should be administered at skin incision to be effective [05:09, 05:58]. - Efficacy of Care Bundles
Maternal hemorrhage care bundles are the most impactful strategy. The California Maternal Quality Care Collaborative (CMQCC) guidelines demonstrated a significant decrease in severe maternal morbidity when implemented by hospitals [07:53, 11:14]. - Early Intervention Trigger
One study successfully reduced postpartum hemorrhage and morbidity by lowering the treatment-trigger threshold for vaginal births from the standard 500 mL to 300 mL [09:23, 09:30]. - Placenta Accreta Management
The incidence of Placenta Accreta Spectrum (PAS) is dramatically increasing. Optimal outcomes are achieved by delivering at a tertiary care center with a pre-planned multidisciplinary team and comprehensive protocols [11:30, 13:14].
ABOUT THE SPEAKER(S)
Beth Clayton, DNP, CRNA, FAANA, FAAN
Professor & Program Director, Nurse Anesthesia Major
University of Cincinnati, College of Nursing
Beth Ann Clayton is a Certified Registered Nurse Anesthetist at the University of Cincinnati Medical Center, a Level I Trauma Center and a Level IV Maternity Hospital. She is also a Professor and Director of the Nurse Anesthesia Program at the university. She is a primary author of the American Association of Nurse Anesthesiology (AANA) Practice Guidelines: Analgesia and Anesthesia for the Obstetric Patient. Beth leads the faculty for the AANA Spinal Epidural and Obstetric Essentials Workshop and serves as a speaker for the Society of Obstetric Anesthesia and Perinatology Fundamentals Workshop. She serves on the AANA Foundation Malpractice Closed Claims Research Committee, focusing on obstetric anesthesia claims. She is a Fellow of both the American Academy of Nursing and the American Association of Nurse Anesthesiology. Beth has been appointed to the Centers for Medicare and Medicaid Services (CMS) Medicare Evidence Development and Coverage Advisory Committee (MEDCAC). Additionally, she has served on the American College of Obstetricians and Gynecologists (ACOG) Council on Patient Safety in Women’s Health Care, the Joint Commission Perinatal Safety Standards Review Panel, and the National Quality Forum Maternal Mortality and Morbidity
