PLD.20 Postpartum haemorrhage: immediate management and failures of adherence to guidelines and prompt actions

• Published in: Archives of disease in childhood. Fetal and neonatal edition Vol. 99; no. Suppl 1; pp. A111 - A112
• Main Authors: Briley, A, Tydeman, G, Seed, P, Waterstone, M, Tribe, RM, Sandall, J, Bewley, S
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group LTD 01.06.2014
• Subjects: Blood; Risk factors
• ISSN: 1359-2998; 1468-2052
• DOI: 10.1136/archdischild-2014-306576.321

Background Postpartum haemorrhage (PPH) remains a common cause of maternal morbidity globally. Widely available treatments exist to treat this common complication, yet incidence and associated morbidities are rising in resource rich countries. Reasons are likely to be complex and multifactorial. Traditional and novel risk factors have been implicated, but the impact of changing practice and guidelines require assessment. Method Data were collected for 10,213 women giving birth in two south England maternity services 2008–2009. Information imported from NHS databases. Cases were randomly selected according to weighted sampling strategy for scrutiny of all maternity records. Details of management of the third stage and actions in response to PPH were collected. Results Third stage management Abstract PLD.20 Table Prophylactic uterotonic % recipients* Syntocinon®10 IU intramuscularly 7.5 Syntocinon® IV bolus 29.5 Syntocinon® 40 IU/50ml infusion 31.8 Syntocinon® infusion 29.4 Syntometrine® 1 amp IM 58.2 Physiological 7.4 *Some received >one uterotonic without PPH diagnosis Initial actions taken after PPH recognised. Abstract PLD.20 Table   Women (%) experiencing blood loss category (ml) Action 25–499 500–999 1000–1499 1500+ All Contraction rubbed up 0.7 4.3 11.3 25.4 3.2 Syntocinon® 2nd dose 1.5 11.6 31.8 52.9 7.8 Catheterised 0.2 3.6 9.3 27.1 2.6 Ergometrine 1.9 8.9 17.3 26.7 5.4 IV cannulation 29.4 83.6 93 89.8 49 Blood taken/sent 0.0 4.3 14.3 38.8 3.5 Conclusion Despite NICE, RCOG and local guidelines Syntometrine® remains commonly used. High incidence of IV treatments may reflect caesarean births. Actions known to be effective at treating PPH may not be promptly instigated.