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Labour and Delivery Posters
The management of moderate pph: an audit from the royal infirmary Edinburgh
  1. N Palaniappan,
  2. L Simpson,
  3. O Keag,
  4. N Mary
  1. Royal Infirmary Edinburgh, Edinburgh, United Kingdom


Background Primary post-partum haemorrhage (PPH) is defined as a blood loss of more than 500mls following delivery. Emergency measures are required to be initiated when a blood loss exceeds 1000mls, as healthy patients are usually expected to cope with a blood loss under this level. Moderate PPH (1000-2500mls) that forms a major bulk of all significant PPH is not subjected to routine analysis as major PPH (>2500mls).

Aim The primary aim of the audit was to assess the management of “moderate” PPH.

Methods Retrospective audit for the year 2009.

Results Total deliveries numbered 6678 of which 464 (6.9%) had a PPH exceeding 1000mL. 417 (6.2%) fitted our moderate PPH category (1000-2500mL). 351 (74%) notes were available for analysis. Syntocinon/syntometrine was effectively used in 99.7% of the cases, oxytocin infusion was used in 66%, Ergometrine was used in 23%, and Carboprost was used in 23%. 11% had manual removal of placenta, 1% had an intrauterine balloon insertion. Only 50% of these patients were observed in the HDU postnatally.

Conclusion Strict adherence to the protocol was seen in majority of the cases although a small deviation from the protocol with beneficial effects to the patient was not uncommon. A methodical use of pharmacological agents was observed. However admission to HDU and documentation were areas for improvement. A user-friendly PPH questionnaire has been written and a prospective audit has been suggested to promote accurate documentation. An audit on HDU admissions has been suggested to assess the optimal use of HDU beds.

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