Postpartum Blood Loss: Implementation of Recommendations Following a Retrospective Audit Resulting in Improved Patient Care

Summary

A three month retrospective audit of 418 deliveries to assess the incidence of postpartum haemorrhage was initiated in 1991. A second, prospective audit of 385 deliveries over three months in 1992–1993 assessed the effectiveness of recommendations implemented following the first. Following the first audit the definition of postpartum haemorrhage was extended to include both visual estimation of blood loss exceeding 500 ml or a drop in haemoglobin concentration of greater than 2–8g/dl–‘an excessive postpartum blood loss’.

Excessive postpartum blood loss was 15.6 per cent in 1991, and was reduced to 11.7 per cent in 1992, principally attributable to reduction in blood loss with operative delivery from 48.2 per cent in 1991 to 250 per cent in 1992. There was a diminished reduction in haemoglobin concentration over delivery in the prospective audit. The reduction in excessive blood loss was from 50.0 per cent to 24.1 per cent with vaginal instrumental deliveries and from 46.2 per cent to 25.8 per cent with caesarean section.

The recommendations implemented following the 1991 retrospective audit have resulted in an improvement in perinatal care, particularly with operative deliveries.