PIH42 HEALTHCARE RESOURCE USE FOR THE MANAGEMENT OF POSTPARTUM HAEMORRHAGE IN FRANCE, ITALY, THE NETHERLANDS, AND THE UK

Abstract

Postpartum haemorrhage (PPH) is the most common major obstetric haemorrhage, occurring in approximately 5% of births worldwide. This study aims to quantify resource use for management of PPH following vaginal birth in hospitals in France, Italy, the Netherlands, and the UK. A web-based survey was developed following consultations with an expert panel. The 76 questions covered resource use for management of major (blood loss >1,000 ml) and minor (500-1,000 ml) PPH compared with uncomplicated births. The survey was completed by 25 midwives/country (n=100) from March-May 2019. All survey participants, excluding five from the Netherlands, agreed that midwives are involved during uncomplicated births and management of PPH. Involvement of additional personnel increased with PPH severity; 76% and 44% of participants reported that consultant obstetricians/gynaecologists are involved in management of major and minor PPH, respectively, compared with 20% for uncomplicated births. Use of additional uterotonics for treatment of major and minor PPH was reported by 92% and 84% of participants, respectively. Other resources administered more frequently for management of major and minor PPH vs. uncomplicated births include intravenous fluids (82% and 60% vs. 28%) and blood transfusions (68% and 7% vs. 2%). Women were expected to spend longer in the delivery room following major or minor PPH (median 5 or 3 hours, respectively) compared with uncomplicated births (2 hours). Additional time in surgical recovery, intensive care, and/or a high dependency unit was reported, particularly for managing major PPH, with France and the UK reporting longer stays than Italy or the Netherlands. The survey identified key resources for PPH management including additional personnel, medical interventions, and locations/time in hospital, with largely comparable results between countries. With rates of PPH increasing in many countries, prevention with effective uterotonics is key to reducing costly resource use associated with management of PPH.