• Richard A Greene, Joye McKernan, Edel Manning, Paul Corcoran, Bridgette Byrne, Sharon Cooley, Deirdre Daly, Anne Fallon, Mary Higgins, Claire Jones, Ita Kinsella, Cliona Murphy, Janet Murphy, Meabh Ni Bhuinneain, and Maternal Morbidity Advisory Group.
• National Perinatal Epidemiology Centre, Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland. Electronic address: r.greene@ucc.ie.
• Eur. J. Obstet. Gynecol. Reprod. Biol. 2021 Feb 1; 257: 114-120.

ObjectiveTo assess major obstetric haemorrhage incidence, management and quality of care in Irish maternity units.DesignIn collaboration with Irish maternity units the National Perinatal Epidemiology Centre (Leitao et al., 2020) carried out a national clinical audit and surveillance of major obstetric haemorrhage (MOH).MethodsMOH was defined as blood loss of at least 2500 ml, transfusion of five or more units of blood or documented treatment for coagulopathy. Co-ordinators in maternity units completed detailed case assessment forms. The denominator data obtained from the individual units was restricted to live births and stillbirths of babies weighing at least 500 g. International Classification of Diseases diagnostic codes from hospital discharge records were used to identify cases of postpartum haemorrhage (PPH) and blood transfusion.ResultsDuring the time period, 2011-2018, there was a 54 % increase in MOH, a 60 % increase in PPH and a 54 % increase in blood transfusion. For 497 reported cases of MOH in 2011-2013, the median estimated blood loss was 3000 ml (range: 600-13,000 ml) and uterine atony was the most common cause. At least one uterotonic agent was used to arrest the bleeding in 94 % of the 477 MOH cases associated with a vaginal or caesarean delivery. A blood transfusion was received in 93 % of cases. Regarding quality of care, the vast majority of reported cases were described as receiving appropriate care and were well managed.ConclusionInternationally, obstetric haemorrhage and especially PPH and its increasing trend remains a major challenge for service providers and clinical staff. A standardisation of definitions of PPH/severe PPH/MOH and agreed approaches to quantitation of blood loss would be valuable developments to allow better investigation and shared learning. Reducing the burden of this morbidity through improvements in care should be a real focus of maternity services.Copyright © 2020 The Authors. Published by Elsevier B.V. All rights reserved.

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