Improving practice and reducing significant postpartum haemorrhage through audit

Abstract

Background In 2012, there was a concern about the incidence of postpartum haemorrhage (PPH) and the prevalence of physiological third stage management at a midwife-led birthing unit. Aims To determine whether midwives considered risk factors for PPH and provided informed choice when planning third stage management, and whether there was any relationship between third stage management and PPH. Methods A cohort of 57 women who experienced a PPH >500mL was identified, and their records audited. Findings were shared with the midwifery team, who generated solutions. These were implemented in 2013/14 and a re-audit was conducted in 2015. Findings The re-audit showed that the incidence of PPH >1000mL had decreased. As a result of improvements in risk assessment and informed consent surrounding third stage management, no women were inappropriately managed physiologically during the third stage. Using an agreed pathway and PPH boxes was associated with an improvement in the quality and speed of treatment. Conclusions The audit cycle was used effectively to review practice. It identified deficiencies and helped the midwifery team to generate solutions, which resulted in improved outcomes for women.