Lessons on Haemorrhage and AFE

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Presentation transcript:

Lessons on Haemorrhage and AFE

Haemorrhage

Background

Direct deaths 2000-2012 per 100,000 maternities

Direct deaths 2006-2012 per 100,000 maternities

Deaths from bleeding: 2009-2012

Who were these 17 women?

How did these 17 women deliver?

Causes of haemorrhage deaths

7 Deaths from Uterine Atony

7 Deaths from genital tract trauma

3 Women had Placental Pathology

Care could have been improved in all cases

Care could have been improved in all cases

Improving estimates of blood loss

Improving estimates of blood loss

Improving estimates of blood loss Small women have small blood volumes 9 women weighed less than 60kg

Improving communication of estimated blood loss

Improving communication of estimated blood loss

3. Improving Resuscitation

Improving Resuscitation

4. Improving Response: Control the bleeding

Turning off the tap

Turning off the Tap: Intra-uterine tamponade

Turning off the Tap: Hysterectomy

5. Improving human factor skills

Key Haemorrhage Messages

Amniotic Fluid Embolism

Direct deaths 2000-2012 per 100,000 maternities

AFE Diagnostic Criteria UK Obstetric Surveillance System (UKOSS) Knight, Tuffnell et al. 2010

11 Women Died from AFE

Clinical presentation of AFE:

Clinical course following collapse

Clinical outcome after AFE

Improving care

Key AFE Messages

Key AFE Messages