Major postpartum hemorrhage: survey of maternity units in the United Kingdom

Abstract

Background. To determine current clinical practice among different maternity units in the United Kingdom for the management of major postpartum hemorrhage. Methods. A postal questionnaire was sent to 258 maternity units in the UK. It was developed to identify the definition of major postpartum hemorrhage, and to identify the medical and surgical interventions used for postpartum hemorrhage, as considered by each unit, and the type and use of thromboprophylaxis following surgery for major hemorrhage after delivery. Results. A total of 212 (82%) returned the questionnaire, but 13 units indicated that the questionnaire was not applicable to them, leaving 199 (82%) for analysis. There was a lack of agreement between the different units regarding the definition and interventions for major postpartum hemorrhage. The majority of the units use oxytocin, ergometrine and carboprost as a ‘first-line’ for the treatment of postpartum hemorrhage. Hysterectomy was the most common surgical procedure (89% of units had performed at least one hysterectomy for major hemorrhage in the last 5 years). There was a lack of agreement regarding the use and choice of thromboprophylaxis following surgery for major hemorrhage. Conclusions. Current management of major postpartum hemorrhage varies considerably. There is an urgent need to identify protocols that will reduce the need for hysterectomy in women with major hemorrhage who are unresponsive to conventional medical therapy.