The role of guidelines in the approach of managing massive postpartum haemorrhage

Abstract

Massive primary PPH is defined as blood loss >1000 ml within 24 hours of delivery, and remains the major cause of maternal death worldwide. We have previously audited massive PPH at our hospital and obtained an incidence of 1.7% in a 6-month period. After updating our guidelines on PPH and informing all staff, we aimed to determine if this would reduce the incidence of massive PPH. All cases of blood loss >1000 ml in the first 24 hours post-delivery were recorded prospectively from 1 January 2002 to 30 June 2002. These cases were identified from the delivery suite, theatre and postnatal ward, and a datasheet completed. Fifteen cases were identified of 3300 deliveries (0.45%), which is significantly lower than the previous 1.7%. Mean maternal age was 27.6 (SD 4.2) years. Seven (46.6%) were primagravida. One (6.6%) had been admitted to hospital with an antepartum haemorrhage. One (6.6%) had a PPH on a previous delivery. Over 50% cases were delivered by caesarean section. One (6.6%) had an estimated blood loss greater than 3000 ml. Thirteen (86.6%) were due to uterine atony. Overall in this series, there was less blood transfusion and fewer admissions to the high-dependency unit.