Background The obstetric hysterectomy rate at BTUH has been reported to be 0.09% – averaging to about 4 per year or 4 per 4500 deliveries. The UKOSS established the national average Obstetric hysterectomy rate to be 0.048%.

Aim To compare our Trust's performance against national UKOSS standards

Methodology A retrospective review of case notes of patients who have had an obstetric hysterectomy during the study period January 2006–December 2010

The data was transferred on to the structured data collection form with 3 parts – pre-PPH care, management of PPH and evaluation of care.

Results The total number of deliveries were 17,600. Of the 740 patients who suffered a PPH of >1 litre, 23 underwent an Obstetric Hysterectomy.

There were major avoidable factors in the care of four patients with the recurring theme being lack of prompt recognition of PPH. There were no avoidable factors in 4 patients.

Conclusion We propose that the criteria for Obstetric hysterectomy, which would include the following factors

Severe hypotension > 6 min

Continued blood loss (>2 L) despite other surgical measures

Inadequate response to blood replacement

ECG changes reflecting hypovolemic hypoxia

imminent DIC/Washout phenomenon

Clinician judgement

be hotly and widely debated before reaching a national consensus, to ensure standardisation of management of PPH.