Continuing Care and Lessons Learned

Continuing Care and Lessons Learned

Following major obstetric haemorrhage, the mother must be care-fully monitored in an appropriate safe environment. Maternal deaths have been attributed to sub-standard care in the postpartum period. All mothers where the bleeding has been estimated > 1500 ml are best cared for in a high dependency environment, even if apparently stable. Hourly observations should be made of pulse rate, blood pressure, urine output, respiratory rate and fluid balance, especially in the first 6 hours. Regular Hb and coagulation studies will need to be performed every 4-6 hours, if the blood transfusion requirements are > 8 units.

Postoperative ventilation is indicated if there is on-going bleeding especially if associated with uncorrected clotting abnormalities, hypothermia, severe oliguria/anuria, pulmonary oedema and poorly corrected metabolic acidosis with an increased lactate > 2.0.

Review

All staff involved in cases of major obstetric haemorrhage should conduct a 'rapid review' of the case, ideally within 48 hours, to examine the effectiveness of the systems involved, to define the lessons learnt and to organize support and counselling as necessary in the event of a bad outcome.