Article Text

Download PDFPDF
Labour and Delivery Posters
Consultant presence during major obstetric haemorrhage
  1. C Harrity,
  2. S Ahmed,
  3. H O’Reilly,
  4. M Cheah,
  5. B Byrne
  1. Coombe Women's and Infants' University Hospital, Dublin, Ireland


Background Consultant presence on labour ward can improve patient outcomes, with recommendations for on-site cover of 60 hours/week in units with ≥5,000 births/year. The study aims to assess the potential impact of introducing these recommendations on the management of major obstetric haemorrhage (MOH) in a unit with >9000 deliveries/year and only 24hr/week of dedicated consultant labour ward sessions.

Methods Data from MOH cases from 01/01/09-30/06/11 was collected using a validated proforma. MOH was defined as an EBL of ≥2.5L, transfusion of ≥ 5 units of Red Cell Concentrate, or treatment of coagulopathy.

Results 70 MOH cases were identified in the study period, with consultant obstetrician presence in 59(84.3%), and consultant anaesthetist presence in 43(61.4%). Consultant obstetrician presence varied depending on the cause of MOH (100% for placenta accreta and coagulopathy, 76.9% for uterine atony, 50% for abruption) and complexity of treatment instigated (100% for hysterectomy, B-Lynch or internal iliac ligation, 86.9% for intrauterine balloon, and 70.6% for RPOC). Consultant obstetricians were present in cases with a higher EBL (3.7L vs 2.6L) and greater requirement for blood transfusion (5.0 vs 3.5 units). The overall rate of ICU admission was 1.4%, 90% were admitted to HDU, and there were no maternal deaths. 47% of cases occurred outside normal working hours (9-5 Mon-Fri).

Conclusions Consultant presence during MOH is already high, and implementation of 60-hour cover may not influence care of these patients, especially as a large proportion occur out-of-hours. Improved consultant presence may possibly benefit outcomes in other areas.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.