Chapter 4: Haemorrhage

Obstetric haemorrhage: Specific recommendations

All staff require regular training on identification and management of maternal collapse, including the identification of hidden bleeding and the management of haemorrhage, which is also a key recommendation of this Report.

An early warning scoring system of the type described in the Chapter on Critical Care, another key recommendation of this Report, may help in the more timely recognition of cases of hidden bleeding.

When severe haemorrhage occurs it is good practice to call straight away for the aid of colleagues with greater gynaecological surgical experience.

The management of women with placenta percreta requires careful multidisciplinary planning in the antenatal period and the involvement of a consultant-led multidisciplinary team at delivery.

Guidelines for the management of women who refuse blood products must be made available to, and discussed with, all maternity staff as part of their routine training, postgraduate education, continuing professional development and practice.

Women should be advised that caesarean section is not an entirely risk-free procedure and can hold problems for current and future pregnancies.

All women who have had a previous caesarean section must have their placental site determined. This, too, is a key recommendation of this Report. If there is any doubt, magnetic resonance imaging (MRI) can be used along with ultrasound scanning in determining if the placenta is accreta or percreta.