Development of new treatment protocols leads to reduction in massive bleeding and transfusion after childbirth across Wales, and changes to national and international clinical practice guidelines.
Postpartum haemorrhage (PPH) is the leading cause of maternal mortality worldwide. The condition has doubled in the UK in the last 15 years, affecting around 5300 women and resulting in more than 750 intensive care admissions per year.
Between 2014 and 2016, it caused 31 maternal deaths across the UK. The bleeding is caused by obstetric complications after delivering a baby and is often made worse by blood clotting abnormalities, including those associated with low levels of the clotting factor fibrinogen.
Research leads to development of new care package for PPH
Between 2008 and 2018 a Cardiff University team lead by Professor Peter Collins developed research to produce a clinical algorithm, designed to rapidly replace fibrinogen based on point-of-care testing.
The team then developed a 4-step care package, rolled out across Wales, which involves making a risk assessment of mothers during labour and closely monitoring blood loss, alongside the use of the algorithm to identify mothers who may need additional measures to stop bleeding.
The research and care package were developed alongside and rolled out in partnership with the University’s excellent NHS colleagues across South Wales, without whom the work could not have been made possible. In particular, obstetric anaesthetists Rachel Collis, Lucy de Lloyd and Sarah Bell alongside countless other midwives, consultants and junior doctors were instrumental in the development of the package and its subsequent use in Wales and beyond.
Challenging the existing approach
The care package, developed between 2008 and 2018, focuses on the following areas:
- Accurate quantification of blood loss during delivery – Cardiff University research showed that visual estimation of blood loss could misestimate by up to 1500ml. The university team and collaborators created a new, more accurate method of estimating blood loss that could be carried out in real time by junior staff.
- Rapid point-of-care testing for bleeding biomarkers – the university team and collaborators embedded the use of a 10-minute point-of-care test for fibrinogen levels, which helped to identify women who would later need blood transfusion and surgical procedures to control bleeding.
- Appropriate use of fibrinogen and other clotting factors – in the absence of point-of-care fibrinogen testing, many women were automatically given early transfusions of fresh frozen plasma (FFP). The research, using the new 10-minute test, discovered the point at which intervention with transfusion and replacement fibrinogen was necessary, leading to fewer unnecessary transfusions.