Objective: Primary Postpartum Haemorrhage (PPH) is the second leading direct cause of maternal death in the UK1 . Within this audit we investigated major severe PPH (MSP) to assess the ability to reduce cases and therefore morbidity.

Design: Local audit project at Kingsmill Hospital, Mansfield UK, using Scottish Program for Clinical Effectiveness in Reproductive Health Data collection tool2 and clinical standards assessed against the Royal College of Obstetricians and Gynaecologists (RCOG): Prevention and Management of Postpartum Haemorrhage3.

Method: Random sampling of 51 cases through the DATIX incident reporting system over a 5 year period 2015-2020 with estimated blood loss (EBL) of ≥2 litres. Data collected for each case included: Age, parity, mode of birth, EBL, haemoglobin, cause and management of PPH etc. Univariate linear regression model was created with EBL as the dependent variable. Factors included in the models were age, parity, cause of PPH, mode of birth, pre and post haemoglobin levels. Age, pre and post haemoglobin levels were handled as continuous variables whilst parity, aetiology and mode of birth were treated as dichotomous variables. Results presented as betacoefficients, p-values and 95% confidence intervals.

Results: Vaginal birth, increasing maternal age and nulliparity were associated with risk of MSP. Atony showed less association with MSP compared to other causes. Assessment on the involvement of the multidisciplinary team (MDT), escalation required, monitoring and management were done and improvements could be made in these instances.

Conclusion: Recommendations were created to improve practices, these could easily be adopted by other units. PPH checklists to be readily available with the PPH rescue box, which ensures management is followed in emergency situations. A poster is to be created highlighting the importance of the MDT involvement and escalation processes, this will be placed in the handover room which all levels of staff use. Early identification of PPH risk factors allows for prevention and preparation of such cases aiming to decrease severity of blood loss. Nulliparity, vaginal birth and increasing maternal age are risk factors for MSP.