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Prospective audit of major obstetric haemorrhage – a pilot study
  1. SN Johnson1,2,
  2. S Varadkar1,
  3. S Khalid1,2,
  4. J Fleming1,
  5. R Fanning1,
  6. C Flynn3,
  7. B Byrne1,2
  1. 1Coombe Women and Infants' University hospital, Dublin, Ireland
  2. 2Royal College of Surgeons of Ireland, Dublin, Ireland
  3. 3St James's Hospital, Dublin, Ireland

Abstract

Background Substandard care is reported to occur in 33% of cases of major obstetric haemorrhage (MOH). Prospective audit of MOH allows assessment of quality of care and stimulates reflective practice. The authors aimed to assess the feasibility of collection of good quality prospective data in our institution.

Methods A multidisciplinary group was formed. The proforma for data collection and definition of MOH (based on the Scottish Audit of Maternal Morbidity (SAMM)) was agreed. Ethics committee approval was obtained. Cases were identified between 1 January and 31 December 2009 inclusive.

Results 31 cases were identified (3.5/1000 maternities). 60% patients were multigravida and two thirds of whom had a previous Caesarean section (CS). 54.7% cases were delivered by CS. Uterine atony (32.2%), retained products of conception (19.3%) and placenta praevia/accreta (19.3%) were the main underlying etiologies. The mean EBL (estimate blood loss) and RCL (red cell concentrate) transfused were 4 litres and 5.2 U respectively. Excellent initial resuscitation including adequate intravenous access and appropriate monitoring was noted. Obstetric consultant presence in placenta praevia cases was 100%. HDU care was received by 90.3% patients. The results will be discussed in comparison to SAMM.

Conclusion This pilot study demonstrates the feasibility of prospective data collection in MOH data in a single unit. Similar definition of MOH allows data comparison between centres. Quality of care appears to be excellent and some areas for potential improvement will be discussed. The authors would aim to extend this audit tool to all of the maternity units in Ireland.

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