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P27 Post-partum haemorrhage admissions to
critical care: completing the audit cycle
A D Evans,  L Rees,  R E Collis  
Department ofAnaesthetics, University Hospital of Wales,
Cardiff, UK
Introduction: Post -partum haemorrhage (PPH) remains a
common cause of obstetric admissions to critical care in
the UK. Our audit (May 2004
association with carboprost (HaemobateTM) and pulmonaryoedema in PPH patients admitted to ITU. Following this, our entire major obstetric haemorrhage guidelines were
revised through multi-disciplinary meetings (obstetricians,
anaesthetists, haematologists, porters). Changes included
revising the algorithm for uterotonics, carboprost became
the last choice and the total dose restricted, early return to
theatre, earlier senior input and early use of clotting factors.
Our PPH admissions to ITU were re-audited (Jan 2007-Jan
Method: Using the intensive care unit (ICU) admission
database, maternity patients were identified over the second
two-year period. The case notes were reviewed to establish
the reason for admission focusing on uterotonic use, fluid
balance, blood products and the use of intrauterine
tamponade balloons. The maternity database was used for
denominator figures and pharmacy ordering data on total
carboprost used within the department. The results were
compared with the previous audit.
Results: Seven patients were admitted to ICU for PPH
compared with 12 in the previous audit. With an increase in
the number of deliveries, 12 160 vs 10 713, this is an
absolute reduction of 51.8%. The main cause of PPH was
uterine atony in four patients (57%). Our use of carboprost
fell by >50% (pharmacy costs) and although three patients
(43%) developed pulmonary oedema, only one received
carboprost and the dose did not exceed the maximum in the
new guidelines. Our hysterectomy rate fell (14% vs 35%)
and 43% of patients were managed with an intrauterine
balloon compared with 29% previously.
Conclusions: Revision of our major obstetric haemorrhage
guidelines has resulted in a fall in critical care admissions
following PPH. Pulmonary oedema due to excessive
carboprost use did not occur and our hysterectomy rate also
fell. Multiple changes occurred after the initial audit, after
deficiencies were highlighted through route-cause analysis,
but we feel that early return to theatre, early use of
ergotamine and restricting carboprost, increasing the use of
uterine balloon tamponades and early use of clotting factors
(prior to clotting results) are all important.
1. Harrison DA, Penny JA, Yentis SM et al. Case mix, outcome and activity f
or obstetric admissions to adult, general critical care units: a secondary analysis of the ICNARC Case Mix Programme Database. Critical Care 2005; 9: S25-S37.
2. Rees L, Collis RE, Harries S. Uterotonics and pulmonary oedema: is there a link? Int J Obst Anesth 2007; 16: S36.


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