Major obstetric haemorrhage in Ireland: Findings from a national clinical audit
Edel Manning
National Perinatal Epidemiology Centre
RGN, RGM, H Dip Clinical Practice, H Dip Diagnostic Ultrasound in Obstetrics and Gynaecology, MSc Health Care Ethics and LawEdel is co-ordinator for the Maternal Death Enquiry in Ireland since its inception in 2009. She has fulfilled this role on a part-time basis in conjunction with her role as a research midwife in the National Perinatal Epidemiology Centre where she is project manager for two national clinical audits of the maternity services in Ireland: Severe Maternal Morbidity and Perinatal Mortality. She has been intrinsic to the development, implementation and refinement of data collection tools used in these clinical audits.Edel trained as a general nurse in the Mater Misericordiae and as a midwife in the Coombe Women and Infants University Hospital, Dublin. Her midwifery experience has been in the CWIUH in a variety of roles including CMM2 within the labour ward and clinical midwife specialist within the ultrasound department.
Abstract
Background Major obstetric haemorrhage (MOH) is one of the major causes of maternal mortality internationally and the most common form of severe maternal morbidity in high-resource countries like Ireland. Aim and objectives of... [ view full abstract ]
Background
Major obstetric haemorrhage (MOH) is one of the major causes of maternal mortality internationally and the most common form of severe maternal morbidity in high-resource countries like Ireland.
Aim and objectives of the study
This study aimed to establish the incidence of MOH in Ireland, to describe the causal factors involved and the management and care provided.
Method
MOH was defined as blood loss of at least 2,500ml, transfusion of five or more units of blood or documented treatment for coagulopathy. Data on MOH cases in 2011-2013 were provided by contributors working in Irish maternity units using an internationally-validated form. Ethical approval was provided by the Clinical Research Ethics Committee of the authors’ institution.
Findings
A total of 500 cases of MOH were reported. The incidence rate per 1,000 maternities increased by 11%, from 2.34 in 2011 to 2.60 in 2013. There was fourfold variation in the MOH rate across the maternity units, which may reflect variation in the method used to estimate blood loss. The most common cause of MOH was uterine atony (40%) followed by retained placenta/membranes (17%). Almost all women received a prophylactic uterotonic agent (93%). For approximately 90% of cases, senior clinicians and midwives were present, management adhered to the unit’s MOH protocol and quality of care was deemed appropriate. Almost all of the women required a blood transfusion (93%). A peripartum hysterectomy was required for 14% of the women in 2011, 11% in 2012 and 9% in 2013.
Conclusions and Implications
The findings underscore the value of ongoing multidisciplinary training in the management of obstetric haemorrhage. Implementation of a specific proforma may be warranted to improve documentation during a major obstetric haemorrhage event. A quantitative approach to estimating blood loss, involving volume and weight assessment, should be considered in all maternity units.
Authors
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Edel Manning
(National Perinatal Epidemiology Centre)
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Paul Corcoran
(National Perinatal Epidemiology Centre)
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Richard Greene
(National Perinatal Epidemiology Centre)
Topic Area
Maternity Care
Session
MC-1 » Maternity Care 1 (10:30 - Wednesday, 4th November, Lecture Theatre 0.32)
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