Assessment of the Impact of an Institutional Obstetric Hemorrhage Control Protocol: Analysis of Maternal Outcomes in a University Hospital in Southern Brazil

Introduction: Postpartum hemorrhage (PPH) is considered an obstetric emergency and remains one of the leading causes of maternal morbidity and mortality. One strategy to address this issue is the implementation of institutional protocols that streamline and coordinate the care provided by the healthcare team. Despite this, many institutions still lack effective measures to ensure maternal safety during labor. Objective: To evaluate maternal outcomes before and after the implementation of an institutional protocol in a public university hospital for the management of postpartum hemorrhage. Methodology: This is an ecological and retrospective study based on publicly available aggregated secondary data from the Brazilian Unified Health System. Variables related to births and delivery complications between 2014 and 2024 at the General Hospital of Caxias do Sul were selected. Statistical analysis was performed using Fisher’s Exact Test, applied through the OpenEpi software. A p-value < 0.05 was considered statistically significant. Results: Based on the findings, stability was identified in the treatment of complications related to the puerperium, in addition to a 19% reduction in uterine curettage procedures, one of the factors associated with PPH. However, a statistically significant increase in suturing of birth canal lacerations was observed, possibly associated with early identification and appropriate management. As a final protocol measure, puerperal hysterectomies increased quantitatively, possibly related to the early adoption of radical therapeutic measures aimed at reducing the number of deaths. Conclusion: Despite demonstrating some more drastic and definitive outcomes, this study reinforces the importance of institutional implementation of PPH protocols, which enable standardized, rapid, and effective care, especially in critical situations. The adoption of emergency kits in obstetric centers, as an essential component of these protocols, has been widely discussed and reinforced, becoming a global trend.