Priority 3 from the Bleeding Disorders PSP

UNCERTAINTY: What is the best haematological approach to management of severe haemorrhage after delivery?  (JLA PSP Priority 3)
Overall ranking 3
JLA question ID 0078/3
Explanatory note

Postpartum haemorrhage (PPH) or major obstetric haemorrhage (MOH) is bleeding that occurs either immediately after birth or within 6 weeks. There are a number of causes of bleeding that health professionals need to be aware of including atony (uterine tone), tears in the perineum, clotting issues and tissue ie placenta.

With an occurrence of 0.78/100,000 postpartum haemorrhage is the 2nd leading cause of death in maternity and has remained at this rate for previous years and this is why it is vital more research and resources are invested in identifying and treating haemorrhages sooner. The MBBRACE (Mother and babies: Reducing risks through Audits and Confidential enquiries across UK) ‘Saving Lives, Improving Mothers’ Care’ report with data from 2014-2016 showed that for 28% of the women who died, an improvement in care may have changed the outcomes.

Working with the Team in the PSP project allowed the questions that affect people with both acute and chronic bleeding disorders to be considered and recognised. Hopefully more research will be funded to understand the causes and better treatments of PPH and prevent further maternal losses.

Evidence Evidence for specific therapies only: Soro M-AP, Denys A, de Rham M, Baud D. Short & long term adverse outcomes after arterial embolisation for the treatment of postpartum haemorrhage: a systematic review. European radiology. 2017;27(2):749-62.
2. Li C, Gong Y, Dong L, Xie B, Dai Z. Is prophylactic tranexamic acid administration effective and safe for postpartum hemorrhage prevention?: A systematic review and meta-analysis. Medicine. 2017;96(1):e5653.
Health Research Classification System category Blood
Extra information provided by this PSP
Original uncertainty examples Which is the most effective treatment for Post Partum Acquired Haemophilia? ~ What is the most effective strategy to manage post part haemorrhage? ~What are the best treatments for PPH?
Submitted by  Not available
PSP information
PSP unique ID 0078
PSP name Bleeding Disorders
Total number of uncertainties identified by this PSP. 66 (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop 7 July 2018