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MATERNAL
MORTALITY

for by the midwives. What he discovered was that the physicians, local ACOG leadership held a conference where Dr. Lillian Liao,
who performed autopsies, would then go to the maternity ward to pediatric trauma chair at University Hospital, lectured on massive
deliver babies. The midwives did not perform autopsies. He hypoth- hemorrhage and the massive transfusion protocol to local
esized that the bacteria from the autopsies were being transferred OB/GYNS. Thereafter, the local ACOG leadership spearheaded
to the laboring patients. Dr. Semmelweis ordered that the physicians the effort to implement this protocol in the largest hospital systems.
to wash their hands and instruments with soap and chlorine prior The rapid availability of blood products undoubtedly has saved
to delivering the mothers. With this intervention, maternal mortality many mothers in San Antonio.
decreased dramatically. What this story of Dr. Semmelweis demon- In summary, I mention Dr. Semmelweis and the implementation
strates is that with careful study of maternal mortality, systemic in- of ‘Massive Transfusion Protocol’ as examples of addressing two
terventions were implemented which then lowered the maternal causes of maternal death, infection and hemorrhage that were re-
mortality. duced through physician- initiated protocols. Under the leadership
In 2011, Dr. Robert Schorlemer, Dr.Margaret Kelley, and Dr. of the Bexar County Maternal Mortality and Morbidity Review
Brian Harle, under the auspices of the American College of Ob- Committee, a thorough investigation of maternal deaths will be per-
stetricians and Gynecologists District XI Section V, led an initiative formed to decrease maternal morbidity and mortality in Bexar
to combat postpartum hemorrhage in San Antonio, the fourth lead- County.
ing cause of maternal death in Texas. The OB/GYN Department
at the UT Health Department had initiated a Massive Transfusion Margaret A. Kelley, M.D. is a graduate of the Warren Alpert Medical
Protocol at University Hospital. This protocol immediately made School of Brown University and the UT Health at San Antonio OB/GYN
available six units of RBCs, FFP, and platelets at the time of massive Residency Program. She practices at Southeast OB-GYN Associates, P.A.
hemorrhage. However, this protocol was not implemented in the She is the Chairman of the Bexar County Maternal Mortality and Morbidity
Methodist Healthcare System or the Baptist Hospital System. The Task Force.

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