Background The incidence of major obstetric haemorrhage (MOH), defined as ≥2.5 litres of blood loss, is rising. It is a leading cause of significant maternal morbidity.¹

Objectives To review the management of MOH in a tertiary maternity unit, compare practice against recommended guidelines¹ and suggest changes for improving future practice.

Method Retrospective review of case notes for 6 months (Jan 2013 to June 2013) in Princess Royal Maternity Unit, Glasgow.

Results There were 28 patients with MOH in the 6 month period, reflecting an incidence of 9.70 per 1000 births.

A consultant obstetrician was less likely to be present overnight 0100–0900 (4 out of 8 patients), when compared to 0900–1700 (5 out of 7 patients) and 1700–0100 (12 out of 13 patients).

A significant number of patients (5 out of 28) received more than the recommended 3.5L of intravenous fluids before receiving blood.¹

There were 7 patients (25%) which could be identified as “high risk” before labour – all of which were identified in the antenatal period. A detailed action plan of management was recorded antenatally in 6 out of these 7 and followed in 5 out of the 7 patients.

Conclusion The unit has been effective in identifying and planning for “high risk” patients. However, there is room for improvement in our management of MOH, such as improving consultant presence and early initiation of blood transfusion.

Reference

1. Scottish Confidential Audit of Severe Maternal Morbidity, 9th Annual Report (2011)