Massive postpartum haemorrhage as a cause of maternal morbidity in a large teaching hospital

Abstract

Obstetric haemorrhage is a recognised cause of maternal morbidity and mortality in the United Kingdom. Postpartum haemorrhage (PPH) of the massive type is the one most likely to result in either severe morbidity or mortality. In this retrospective study, we reviewed all cases of massive PPH in our unit over a 4-year period with the aim of characterising the factors associated with the haemorrhage, its management and associated morbidity. All cases of PPH were identified from the obstetric database of the Leicester Royal Infirmary for the period 1997–2001 (inclusive). Only those cases in which the estimated blood loss was at least 15 000 ml were included in the study. The case notes of the patients were retrieved and various variables collected for analyses. Over the 4-year period, there were 27 106 deliveries at the unit and 145 women suffered from massive PPH—an incidence of five per 1000 deliveries. Sixty-one (42%) were in multiparous women and of these, 12 were in those with four or more previous deliveries. There was associated antepartum haemorrhage in 12 cases, five of which were placental abruptions. Estimated blood loss was over 2000 ml in 46 cases. Risk factors included prolonged labour, emergency caesarean section for failure to progress especially in the second stage (34) and placental praevia (10). Four cases underwent an abdominal hysterectomy.