150 posters, 16 sessions, 294 authors, 70 institutions
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Obstetric Anaesthesia Annual Scientific Meeting 2024
Thursday 9 - Friday 10 May 2024, Birmingham
6300008
Tranexamic acid use in postpartum haemorrhage: a quality improvement project
Poster Presenter
Authors
Charlotte Topham, Jonathan Matthews, Julia Blackburn, Zoe Riddell, Catherine Browne, Jatinder Kaur
Affiliations
null,
Part of Topic
Title: Tranexamic Acid Use in Postpartum Haemorrhage - a Quality Improvement Project
Authors: Charlotte Topham, Jonathan Matthews, Julia Blackburn, Zoe Riddell, Catherine Browne and Jatinder Kaur
Birmingham Women’s and Children’s NHS Foundation Trust
Introduction
Postpartum haemorrhage (PPH) is the commonest cause of maternal death worldwide. Tranexamic acid (TXA) is an anti-fibrinolytic used in haemorrhage management.
The RCOG recommends TXA is considered in PPH management [1], citing the association of TXA administration with the lower incidences of blood losses of > 500ml from vaginal birth and >1000ml from caesarean section.
The WOMAN trial, 2017 [2] found that death due to postpartum bleeding was significantly reduced in women given TXA, especially if given within three hours of giving birth.
Objective
Improve the use of TXA in PPH management in our department using targeted improvement interventions.
Aim
To achieve 100% of patients with PPH >1000ml (following any mode of delivery) receiving 1g intravenous TXA within three hours of delivery.
Methods
1. 2022 Audit
36 cases of PPH for which the estimated blood loss (EBL) was >1000ml were auditted.
2. Targetted Interventions
- posters displayed in delivery suite/theatres
- inclusion of TXA into the MDT obstetric emergency mandatory training
- presentation to multiprofessional staff groups at teaching/audit meetings
- encouraging buy-in across the MDT
- 100% compliance target met
- Able to implement changes and measure the impact through audit
- Further work needed in some areas, which this audit helped to identify
- Real, tangible change
- Systematic approach, sustainable and can to be taken forward for future audit, to contribute to a high standard of care in our centre
- Fundamentally a trainee-led QI Project – our small part of a key change in practice which is much greater
- Keep auditing and maintaining good practice
- Improve rates of TXA administration to patients with PPH of 500-1000mls following vaginal delivery
- Documentation of swab weighing - ongoing
- PPH drugs grab box
- PPH risk assessment
1] Mavrides, E,Allard, S,Chandraharan, E,Collins, P,Green, L,Hunt, BJ,Riris, S,Thomson, AJ on behalf of the Royal College of Obstetricians and Gynaecologists.Prevention and management of postpartum haemorrhage. BJOG 2016; 124: e106– e149
[2] Shakur, H., Roberts, I., Fawole, B., Chaudhri, R., El-Sheikh, M., Akintan, A., Qureshi, Z., Kidanto, H., Vwalika, B., Abdulkadir, A. and Etuk, S., 2017. Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial. The Lancet 389(10084), pp.2105-2116
The authors would like to acknowledge the contributions of Dr Kerry Cullis, consultant anaesthetist, Dr Aled Morgan and Sarah Allen, Practice Development Midwife, Birmingham Women’s and Children’s NHS Foundation Trust.