Massive post-partum haemorrhage and management of disseminated intravascular coagulation

Death from haemorrhage fell in the last triennial report from 5.5 to 3.3 per million maternities in the UK. Although the Confidential Report into Maternal Deaths in the UK 1997–1999 continues to make recommendations in relation to the management of obstetric haemorrhage in an attempt to improve the overall level of care, it is disappointing that care was considered to be substandard in 11 of the 14 cases reviewed. While various risk factors can be identified for post-partum haemorrhage, further improvements in care can only occur with dissemination of good practice and adoption of local protocols designed to deliver the optimal care to women in their care. The general management of massive post-partum haemorrhage has been outlined previously in Current Obstetrics & Gynaecology. Disseminated intravascular coagulation plays a significant role in the deaths described in the most recent Confidential Report, and this article focuses on the recent developments in managing coagulation problems as a result of massive post-partum haemorrhage.