Postpartum haemorrhage

This course is part of the RCOG Core Knowledge series.

The eleventh MBRRACE-UK annual report of the Confidential Enquiry into Maternal Deaths and Morbidity, includes enquiries into the care of women who died between 2020 and 2022 in the UK and Ireland. The overall mortality rate from obstetric haemorrhage is 0.89 per 100,000 maternities (95% CI 0.53-1.40). Deaths from obstetric haemorrhage remain the second most frequent direct cause of maternal death after thrombosis and thromboembolism. Although not statistically significant, the rates of maternal mortality from haemorrhage continue to marginally increase. MBRRACE highlight the consistency of this increasing rate and a troubling trend of increasing maternal deaths due to direct causes.

In the tenth MBRRACE report, there was a focus on obstetric haemorrhage in Chapter 3. The reviewers identified that improvements to care may have made a difference to outcome in 72% of maternal deaths from this cause. Recurring learning themes centred on recognition of the clinical signs of significant blood loss, delays in treatment associated with NHS systems under pressure and the need for situational awareness and senior leadership. Important messages included need for specialist care for women with abnormally invasive placentation, the management of obstetric haemorrhage and around the prioritisation of emergency versus elective caesarean births.