Objectives Identify trends in clinical care and system failures that contribute to postpartum haemorrhage (PPH). To re-audit practice against Scottish PPH proforma. To compare effect of recommendations made in the previous audit on incidence and outcomes of PPH.

Material and methods Audit of 23 cases of PPH that were reported as critical incidents between 3 months were reviewed to establish compliance with local guidance.

The incidents were critically analysed by Divisional clinical-risk team lead by obstetric consultant. The deficiencies in quality of clinical obstetric care were identified. Changes to the guideline on management of PPH and massive obstetric haemorrhage, including simplified flowchart were made. Prospective reaudit carried over same period after 2 years, demonstrated reduction in PPH cases to 8.

Results The recording of EBL (estimated blood loss) remained poor in majority of cases. There were 10 (44%) preventable, 8 (35%) predictable cases. There were two instances where syntocinon infusions were not commenced in timely manner. There was evidence that, standard of care could have been improved in at least half of cases. The root-causes leading to inadequate care were considered to be multifactorial systems, failure of clinical and guideline adherence.

Reaudit showed that cases of PPH had decreased significantly when changes were implemented.