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. 2020 Apr;60(2):212-217.
doi: 10.1111/ajo.13040. Epub 2019 Jul 26.

Severe maternal morbidity due to obstetric haemorrhage: Potential preventability

Sam J Lepine  1   2 , Stacie E Geller  3   4   5 , Megan Pledger  4   5 , Beverley Lawton  4   5 , Evelyn Jane MacDonald  4   5
Affiliations

Severe maternal morbidity due to obstetric haemorrhage: Potential preventability

Sam J Lepine et al. Aust N Z J Obstet Gynaecol. 2020 Apr.

Abstract

Background: Haemorrhage in pregnancy may be life-threatening to woman and infant. The impact of severe obstetric haemorrhage can be reduced by detecting high-risk women, implementing guidelines and treatment plans, early detection of hypovolaemia and timely appropriate treatment.

Aims: To describe cases of severe maternal morbidity caused by obstetric haemorrhage in New Zealand and investigate the potential preventability of these cases.

Materials and methods: A multidisciplinary expert review panel was established to review cases of obstetric haemorrhage admitted to intensive care or high-dependency units over an 18-month span in New Zealand. Cases were critically analysed by a multidisciplinary team of clinicians to determine the potential preventability.

Results: One hundred and twenty cases were identified, most commonly due to postpartum haemorrhage with 36% (n = 43) deemed potentially preventable, mainly due to delay or failure of diagnosis (65%, 28/43) and/or failure or delay in treatment (91%, 39/43). Twenty-three per cent of cases (28/120) resulted in peripartum hysterectomy of which one-third were deemed potentially preventable.

Conclusions: Prompt recognition and treatment in accordance with evidence-based guidelines is imperative to decrease the burden of morbidity from obstetric haemorrhage. An emphasis on training clinicians to identify haemorrhage in a timely way may avoid unnecessary obstetric emergencies and can improve maternity and neonatal outcomes.

Keywords: maternal health; obstetrics; peripartum; postpartum haemorrhage; preventative medicine.

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