Presented September 4, 2025 at the 2025 APSF Stoelting Conference on “Transforming Maternal Care: Innovations and Collaborations to Reduce Morbidity and Mortality”
SUMMARY
Megan Rosenstein, MD, MBA, FASA’s presentation focuses on the critical role of change management and multidisciplinary team alignment in implementing evidence-based protocols to reduce maternal anemia and hemorrhage. The project, spurred by New Jersey’s poor maternal outcomes and an institutional history of high C-section hemorrhage rates, employed a continuous Quality Improvement (QI) approach across the entire continuum of maternal care. Key interventions included standardizing antipartum anemia screening and treatment (specifically facilitating IV iron access) and implementing a 500 mL Quantitative Blood Loss (QBL) huddle to improve early hemorrhage recognition, teamwork, and combat care delays. These efforts led to a significant reduction in hemorrhage rates.
Key Points:
- Change Management as Core Strategy
The primary challenge was not defining best practice but achieving buy-in and standardization across diverse provider groups (Ob/Gyn, Midwifery, etc.) [01:06, 10:26]. Anesthesia utilized a QI-driven, multidisciplinary team (including MFM, Hematology, Nursing) to align practices and create a “burning platform” for change [06:56, 11:04]. - Antipartum Anemia Optimization
Antipartum anemia is a modifiable, high-impact risk factor for Severe Maternal Morbidity (SMM), with an independent odds ratio of 1.29 for obstetric hemorrhage, exceeding that of preeclampsia or obesity [08:15, 09:12]. It is also a health equity issue disproportionately affecting Black and Hispanic communities [08:41]. - Facilitating IV Iron Access
The QI team standardized a CBC and ferritin screening algorithm (1st, 2nd, and 3rd trimesters) and created a bypass pathway for simple iron deficiency anemia, allowing providers to order intravenous (IV) iron infusions without a dedicated Hematology consult [09:54, 12:30]. - Hemorrhage Huddle at 500 mL QBL
To address denial, delay, and dismissal (“the 3 Ds”), the system implemented a mandatory hemorrhage huddle triggered at 500 mL Quantitative Blood Loss (QBL) for both vaginal and cesarean deliveries [14:04, 14:13]. - Empowerment and Resource Alignment
The huddle can be triggered by any team member to create a psychologically safe environment and a shared mental model [14:13, 14:26]. The process also mandated the immediate arrival of additional RN and OB resources to the bedside, proactively removing barriers to asking for assistance [14:33, 14:41].
ABOUT THE SPEAKER(S)
Megan Rosenstein, MD, MBA, FASA
Associate Chief Medical Officer,
Director of Obstetric Anesthesia,
Overlook Medical Center, Summit, NJ
Meg Rosenstein, MD is the Associate Chief Medical Officer and Director of Obstetric Anesthesia at Overlook Medical Center in Summit, New Jersey. She joined the medical staff in 2009 following training at NYP Weill Cornell Medical Center. Meg has a passion for health equity and improving birth outcomes for all women and their babies. Aligned with these goals, she sits on the Board of Directors for the Society for Obstetric Anesthesia and Perinatology. Meg is a proud mom of three boys, loves time spent outdoors, and travelling with her family.
