How are maternity units escalating care during postpartum haemorrhage?

Amrit Dhadda, Alexander Johnson, Sarah Bell   |  University Hospital of Wales, Cardiff, UK

Introduction

Effective multidisciplinary team (MDT) working is required during postpartum haemorrhage (PPH), with escalation of care needed to support time-critical decision making and interventions.

Clear triggers should be agreed for MDT escalation, including when to contact the obstetric anaesthetist.  Despite defined thresholds for escalation in RCOG PPH guidelines

Aim

To describe baseline MDT escalation of PPH care in maternity units enrolled in the OBS UK trial, before implementation of the OBS UK care bundle.

Methods

Baseline data describing escalation in PPH was collected using two different methods from the maternity units across England, Scotland and Northern Ireland participating in the NIHR-funded OBS UK trial (REC 23/NW/0242, ISRCTN 17679951).

1. Survey as practice - work as described

A survey of local PPH guidelines and protocols was submitted by all 36 units at the start of the trial prior to implementing the OBS UK care bundle. The survey included specific questions regarding escalation to senior midwifery, obstetrics and anaesthetic teams.

Descriptive statistics were used to examine baseline escalation protocols.

2. Audit of practice - work as done

A baseline audit of practice of 10 cases of >1L PPH was completed by all maternity units prior to implementing the OBS UK care bundle. Data was available for 12/36 units who had begun implementation prior to November 2024.

Analysis involved univariate statistics (counts, percentages) for MDT involvement by PPH volume. Box-and-whisker plots were produced using Microsoft Excel. Pearson’s chi2 tests examined escalation by PPH volume.