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295: Causes of massive obstetric haemorrhage and outcomes of medical and surgical management strategies

      Objective

      Maternal mortality from haemorrhage in the UK increased in last triennium, but 80% of deaths received substandard care. The aetiology of massive obstetric haemorrhage (MOH) is changing and the efficacy of recent developments in medical and surgical management requires evaluation. This prospective audit was established to determine the incidence and aetiology of MOH and the success rates of medical and surgical interventions in our population

      Study Design

      This prospective study from Jan 1st 2004 to Dec 31st 2007 recorded cases requiring acute transfusion of five or more units of blood (RCC) from the three Dublin maternity hospitals, with circa 24,000 deliveries annually

      Results

      Of 93,291 deliveries over four years, there were 129 cases: the incidence of massive obstetric haemorrhage was 1.38/1000. There was one maternal death. The mean number of RCC transfused was 8 units +/− 5(SD). 60% of the women were multiparous and 26% had had a previous caesarean section (CS). Leading causes of MOH were uterine atony (49%), retained placental tissue (24%), placenta praevia (18%), cervical or vaginal trauma (16%), placenta accreta (12%) and broad ligament or uterine tears (10%). Medical therapies employed were oxytocin infusion (81%), misoprostol (64%), carboprost (33%), ergometrine (31%) and recombinant factor VIIa (4%). Medical management alone was successful in 28%. The success rate of surgical interventions was as follows: the hydrostatic balloon (80%), B-Lynch suture (40%), uterine artery ligation (50%) and internal iliac artery ligation (36%). 28 hysterectomies were performed. Interventional radiology was employed in one case

      Conclusion

      The incidence of MOH in our population is comparable to other reports using similar definitions. Uterine atony is the main cause of MOH but many women had multiple causes (38%). Although placenta praevia and accreta remain important causes of MOH, preventative methods for MOH should focus on early identification and aggressive management of uterine atony, retained placental tissue, and cervical and vaginal tears