8. Obstetric Haemorrhage

  1. Ian Johnston2,
  2. William Harrop-Griffiths3 and
  3. Leslie Gemmell4
  1. David Levy

Published Online: 10 NOV 2011

DOI: 10.1002/9781118227978.ch8

AAGBI Core Topics in Anaesthesia

AAGBI Core Topics in Anaesthesia

How to Cite

Levy, D. (2011) Obstetric Haemorrhage, in AAGBI Core Topics in Anaesthesia (eds I. Johnston, W. Harrop-Griffiths and L. Gemmell), Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781118227978.ch8

Editor Information

  1. 2

    Raigmore Hospital, Inverness, UK

  2. 3

    Imperial College Healthcare NHS Trust, London, UK

  3. 4

    Wrexham Maelor Hospital, Wrexham, UK

Author Information

  1. Nottingham University Hospitals, NHS Trust, Queen's Medical Centre Campus, Nottingham, UK

Publication History

  1. Published Online: 10 NOV 2011
  2. Published Print: 29 NOV 2011

ISBN Information

Print ISBN: 9780470658628

Online ISBN: 9781118227978



  • obstetric haemorrhage;
  • maternal mortality, morbidity;
  • placental abruption, and APH;
  • antepartum (APH) or postpartum (PPH);
  • UK triennial CMACE report;
  • staff multidisciplinary ‘fire drills’;
  • Lieno-renal axis aneurysms;
  • Care Quality Commission (CQC);
  • emergency anaesthesia


• Obstetric haemorrhage is a major cause of maternal mortality and morbidity throughout the world.

• Placental abruption and placenta praevia are the major causes of antepartum haemorrhage.

• The syndrome of cardiovascular collapse, hypoxaemia and coagulopathy, previously known as ‘amniotic fluid embolism’, has been renamed ‘anaphylactoid syndrome of pregnancy’ to reflect an immune-mediated aetiology.

• The four Ts – Tone (uterine atony), Tissue, Trauma and Thrombin (coagulopathy) – are the major causes of postpartum haemorrhage.

• Placenta accreta is an abnormally deep placental attachment to the uterine muscle. The National Patient Safety Agency has published a six-element care bundle for women undergoing caesarean section and who are at high risk of placenta accreta (principally placenta praevia after a previous caesarean section) and life-threatening haemorrhage.

• Interventional radiology offers the facility to place balloon-tipped catheters in the uterine arteries before elective, high-risk surgery. Embolization of the anterior branches of the internal iliac arteries can resolve unanticipated postpartum haemorrhage whilst preserving the uterus.

• Uterine compressive sutures and intra-uterine balloon tamponade have been used separately and in combination.

• Based on current regimens for major trauma, red cells and fresh frozen plasma have been recommended in a 1:1 ratio with pre-emptive platelet transfusion. There should be a low threshold for giving fibrinogen concentrate.

• Recombinant Factor VIIa has been recommended after failure of conventional therapies but before caesarean hysterectomy.

• Once haemorrhage has been controlled definitively, the need for thromboprophylaxis must not be forgotten.