Introduction Haemorrhage is a leading cause of maternal death and morbidity. Major postpartum haemorrhage (PPH) is loss of more than 1 Litre of blood from the genital tract postnatally.

Objectives To undertake a retrospective audit of patients who underwent a major PPH. Identify areas of good practise and make recommendations to improve standard of care.

Materials and Methods 197 cases were identified from the electronic database (September 2011 to March 2012) and 127 notes reviewed retrospectively. Data was analysed for patient demographics, risk factors, delivery and documentation. Reference was made to the RCOG Green-Top Guideline No. 52 and a previous local audit.

Results The majority were Caucasian (40%), nulliparous (50%), aged 18–30 (61%) with a normal BMI (47%). Most were delivered by Caesarean section (69%) at term (61%). 60% of babies weighed between 3 and 4 kg and 10% of women were estimated to have lost 2.5 L or more. 27 patients required blood transfusion of up to 10 units. There were 6 manual removals of placentae and 8 other surgical interventions, including one hysterectomy.

Discussion There was no correlation between the number of risk factors and total blood loss. An improvement in the completion PPH proformas and patient debriefing was found. However, there appeared to be deterioration in emergency call-out (2222) and incident reporting in comparison to previous audit data.

Recommendations We recommend refresher training and emergency drills for identification and management of the critically ill patient. Improve awareness of local and regional guidelines and re-audit in one year.