Organizational Aspects of Managing Major Obstetric Haemorrhage

Organizational Aspects of Managing Major Obstetric Haemorrhage

Prevention and Planning

It is important to try to identify the patient at risk of major haemorhage by understanding the known risk factors which include: grand multi-parity, increased maternal age, multiple pregnancies, and women with complex medical problems, prolonged and/or obstructed labour and where there is placental abruption or fetal death.

Beware of the patient who has had a previous CS and presents with a placentra praevia in her current pregnancy. She is at high risk of placenta accrete, a condition where the placenta grows into the previous scar tissue. The placenta does not separate after delivery, the uterus cannot contract and life threatening heamorrhae rapidly follows. These patients should only be delivered, if at all possible, where blood transfusion facilities exist.

Preparation (Practice, Protocols and Audit)

A team approach between obstetricians, anaesthetists, midwives and theatre staff is essential, including good communication and effective action. Without team skills, the patient may still die despite individual clinical skill and effort. Communication and team building exercise or drills can be organized outside clinical time and have been shown to reduce the number of deaths. Written local protocols, to which every member of the team has contributed and are beneficial. If problems arise during the management of major haemorrhage, time should be made afterwards for discussion so that improvements can be made for future events.