Keywords
Major obstetric hemorrhage; Postpartum hemorrhage
Abstract
Background:
Major Obstetric Hemorrhage (MOH) is a leading cause of Severe Maternal Morbidity (SMM) world-wide, and around 50% of cases are potentially preventable.
Aim:
To present in-depth descriptive evaluation of the clinical pathway of cases of MOH identified in a SMM review, to highlight clinical action points for improvement in care.
Method:
A secondary analysis of the clinical pathway of women who were pregnant or within 42 days of pregnancy who were admitted to an intensive care unit or high dependency unit after suffering a major obstetric hemorrhage (defined as ≥2L blood loss) from 1st March 2011 - 31st August 2012 from four District Health Boards in New Zealand.
Results:
Forty-three women with major obstetric hemorrhage were identified. Of 11 women with identifiable risk factors only 6 had a documented plan for active management of third stage and preparedness for prevention of postpartum hemorrhage. Drug management varied and resuscitation was often inadequate. Uterine atony was the commonest source of bleeding (40%). The most common intervention after drugs was intra-uterine balloon, of which 77% were successful. B-Lynch sutures and interventional radiology were less frequently used. Four women required hysterectomy.
Conclusion:
This study highlights where improvements in clinical care and systems are needed, and gives recommendations to reduce the severity of morbidity for women suffering this severe obstetric event. These include recognition and documentation of risk factors, plan for active management of third stage, routine use of Modified Early Obstetric Warning charts, and adequate resuscitation.
Citation
Langton E, MacDonald EJ, Abels P, Lawton B and Geller S. Major Obstetric Hemorrhage: What Can We Learn from Severe Maternal Morbidity Case-Series Review?. SM J Gynecol Obstet. 2017; 3(2): 1022.