Severe maternal morbidity due to obstetric haemorrhage: Potential preventability

Area of Science:

• Obstetrics and Gynecology
• Maternal Health
• Critical Care Medicine

Background:

• Severe obstetric haemorrhage poses life-threatening risks to both mother and infant.
• Early detection of high-risk pregnancies, adherence to guidelines, and prompt management of hypovolaemia are crucial for reducing mortality and morbidity.
• Implementing standardized treatment plans can mitigate the impact of obstetric emergencies.

Purpose of the Study:

• To document severe maternal morbidity cases attributed to obstetric haemorrhage in New Zealand.
• To evaluate the preventability of these severe maternal morbidity cases.

Main Methods:

• A multidisciplinary expert panel reviewed cases of obstetric haemorrhage requiring intensive or high-dependency care over 18 months in New Zealand.
• Cases were critically analyzed to determine potential preventability by a team of clinicians.

Main Results:

• 120 cases of severe obstetric haemorrhage were identified, with postpartum haemorrhage being the most common cause.
• 36% (43/120) of cases were deemed potentially preventable, primarily due to diagnostic delays (65%) or treatment delays (91%).
• 23% (28/120) of cases necessitated peripartum hysterectomy, with one-third of these being potentially preventable.

Conclusions:

• Prompt recognition and evidence-based treatment are essential to reduce morbidity from obstetric haemorrhage.
• Enhanced clinician training in timely haemorrhage identification can prevent obstetric emergencies and improve maternal and neonatal outcomes.