latest health care news

09.11.17

Report finds huge disparity in maternal haemorrhage risk in hospitals

The risk of heavy blood loss during childbirth more than doubles in some hospitals, a report by the National Maternity and Perinatal Audit (NMPA) has revealed.

The report, which looked at around 92% of births across England, Wales and Scotland in 2015/16, found that 2.7% of women across England and Wales lose 1500ml or more of blood during or after delivery of a single, term baby.

In some maternity services this increases to 5.6% of women. Some services had a major haemorrhage incidence of just 1.1%, and this variation was found even after adjustment was made for differing case mixes seen by the different services providers.

Obstetric haemorrhage is associated with an increased risk of maternal illness and death, with 13 in 100,000 women as a result of it between 2012 and 2014..

Although the reasons for the variation in haemorrhage rates is not clear, the NMPA has suggested that services with low incidents of obstetric haemorrhages reported may be due to the poor practice of estimating blood loss based on visualisation, rather than a more accurate method, such as weighing swabs.

It therefore recommends that professional bodies and policymakers should investigate the causes of this variation and develop tools to reduce it.

National bodies should also develop initiatives to predict, prevent and recognise severe obstetric haemorrhage.

Professor Lesley Regan, president of the Royal College of Obstetricians and Gynaecologists, said:  “While the UK is a safe place for women giving birth, this report shows variation in care and outcomes for women and babies in maternity services in Britain.

“While some variation is expected and can drive new improvements, unwarranted or unexplained variation requires investigation.

“We urge all maternity units to examine their own results and those of their neighbours both to identify role models and to drive quality improvement locally.”

Royal College of Midwives’ head of quality and standards, Mandy Forrester, added: “More investment in our maternity services, and crucially an investment in more midwives and resources is needed to improve data quality.

“These initial results, however, identify opportunities for sharing good practice, as well as highlight increasing pressures on the service from demographic changes.”

Speaking on behalf of NHS services in England, Dr. Matthew Jolly, national clinical director for Maternity Review and Women’s Health, said: “The report confirms that, despite the increasing numbers of complex births, the vast majority of women receive high quality care and deliver healthy babies.

“This comprehensive assessment of performance will act as an important resource and benchmark for maternity services in England as we continue to make maternity services safer and more personal.”

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