Obstetric Anaesthetists' Association Survey Tool

114: Survey on the Management of Major Obstetric Haemorrhage

Dear Lead Obstetric Anaesthetist,

We would be very grateful if you would take a few minutes to complete this survey on current management of obstetric haemorrhage in the UK.

It is being sent to all lead obstetric anaesthetists with the aim of providing evidence of current practice particularly relevant to anaesthetists.

We are looking at three important areas:

1. availability of blood and blood products, including prearranged agreements on the immediate issuing of blood and blood products.
2. access to diagnostic and interventional radiology services
3. provision of training and anaesthetists involvement in this service.

There are recent guidelines1 outlining what blood products should be obtained in the event of a  severe major obstetric haemorrhage(>2000ml )1, and this survey would aim to establish if this was being achieved in practice across the UK.

Access to accurate ante-natal diagnosis of the placental site was cited as an important preventative measure in the latest CEMACH report2, so after nearly 3 years it would be of value to assess if this service is widely available across the UK.

The most recent survey considering access to interventional radiological services3, highlighted vast differences in service provision across the UK. However, in the 3 years since this survey, the picture may have changed, and an indication of the level of provision across the UK, may help plan services for the future.

Finally, training has been highlighted as a key factor to raise the standards of health care to women who have major obstetric haemorrhage1.This study would aim to establish what training is being delivered, and the extent to which anaesthetists are involved in providing that training.

We think that this survey will give us an important indication of current practice and highlight differences in practice across the UK, which may need to be subsequently addressed.

Thank you for your time in completing this questionnaire

Yours sincerely,
 
Huw Evans
Specialist Registrar,Welsh School of Anaesthesia

Eleanor Lewis
Consultant Anaesthetist
Singleton Hospital
Swansea

1.Royal College of Obstetricians and Gynaecologists: Prevention and Management of Postpartum Haemorrhage. Green Top Guideline 52: London, RCOG 2009

2. Lewis G. Saving Mothers’Lives.2003-2005.The Seventh Confidential Enquiry into Maternal Deaths in the UK.CEMACH.London.RCOG.2007

3. Webster VJ, Stewart R, Stewart P.A Survey of Interventional Radiology for the Management of Obstetric Haemorrhage in the UK. Int J Obstet Anesth:2010:19; 278-281

 

114: Survey on the Management of Major Obstetric Haemorrhage
(1) How many deliveries a year do you have in your obstetric unit?




(2) How many cases of severe major obstetric haemorrhage (>2000ml) have occured in your unit in the past 12 months?






(3) When managing a severe major obstetric haemorrhage (>2000ml), does your unit have an agreed form of words, or a code that will alert blood bank staff to the urgency of the clinical situation?

Details
(4) When managing a severe major obstetric haemorrhage, does your unit have a pre-arranged agreement with blood bank staff, permitting the issuing of some blood and blood products, without awaiting laboratory results or advice from a haematologist? If yes, what products have been agreed to be available for this situation?

Details
(5) Is fibrinogen concentrate available in your hospital? If yes, how often do you think it has been used in this situation, in the last 12 months?

Details
(6) Is recombinant factor VIIa available in your hospital? If yes, how often do you think it has been used in this situation in the last 12 months?

Details
(7) When uterine atony is perceived to be the cause of the major haemorrhage, what is your usual first line pharmacological treatment (in the absence of maternal cardiovascular disease)?:



(8) When uterine atony is perceived to be the cause of the major haemorrhage, do you routinely consider ergometrine (unless contraindicated)


(9) When uterine atony is perceived to be the cause of the major haemorrhage, do you routinuely consider carboprost (unless contraindicated)?


(10) Is there 24 hour access to intra operative cell salvage for unexpected major obstetric haemorrhage?


(11) Is the placental site routinuely localised using ultrasound, usually at 20 weeks, in all women who have had a previous Caesarean section?


(12) If there is concern regarding the placental site, is MRI imaging performed?




(13) Does your unit offer women with identified placenta accreta/percreta, prophylactic occlusion of pelvic arteries using interventional radiological techniques?
NB. The live survey offers a textbox against the answer(s) for additional information.
(14) Is there 24 hour access to interventional radiological services for patients with unexpected major obstetric haemorrhage?
NB. The live survey offers a textbox against the answer(s) for additional information.
(15) Do you practise major obstetric haemorrhage drills or rehearsals?

(16) Which staff are included?
      Tick all that apply







(17) How often is the major obstetric haemorrhage drill practised?





Details
(18) Are staff informed of the drill practice beforehand, or is it run as a 'surprise'?

(19) Are there any other types of training performed for major obstetric haemorrhage?
      Tick all that apply
NB. The live survey offers a textbox against the answer(s) for additional information.
(20) Are the obstetric anaesthetists in your unit involved in providing this training?

(21) If yes, to previous question, which groups do they teach?
      Tick all that apply





(22) General Comments