A review of the current management of postpartum haemorrhage in the Republic of Ireland, using a case study approach

Abstract

Objective: To get a better understanding of the steps taken during a postpartum haemorrhage (PPH) in the Republic of Ireland. Design: Population-based retrospective cohort study. Hospital births in Ireland during 2020. Methods: A PPH proforma data collection tool was used to understand what occurred during each PPH, the management provided to the woman and the medication received. Main outcomes: Escalation of care to multidisciplinary team (MDT), mode of birth, quantifying blood loss. Results: The 53 PPH proformas collected from two maternity units were comprised of: 43 per cent (23) mild PPH (500–1000ml); 34 per cent (18) moderate PPH (1000–1500ml); and 22 per cent (12) severe PPH (over 1500ml). The blood volume ranged from 500ml to 4.1litres. The most immediate response on recognition of a PPH, by midwives or obstetric doctors who diagnosed the blood loss following childbirth as excessive, was to administer a Syntocinon infusion as the first line of treatment. Conclusions: Potential improvements for care during a PPH include: the first treatment of ‘hand on fundus, call for help’; midwives managing the PPH with use of other treatments and medications while escalating care; timely escalation of emergency phone; an MDT approach to manage the PPH; and quantification of blood loss.