Publication:

Postpartum hemorrhage prevention through audit and review of literature

Background Postpartum haemorrhage (PPH), particularly significant cases with blood loss >1000 ml, is a critical obstetric emergency. This audit evaluated PPH management at Khaja Banda Nawaz Teaching and General Hospital, addressing a high incidence of PPH (29.5%).

Methods A retrospective audit, at Khaja Banda Nawaz Teaching and General Hospital, Kalburgi, Karnataka, India conducted between period of February and May 2024, reviewed 1786 vaginal births from 2022 to 2023, identifying 526 PPH cases (>500 ml), including 71 cases of PPH>1000 ml (4%) and 20 cases ≥2000 ml (1.1%). Compliance with NICE guideline NG235 standards was assessed. Recommendations were implemented from June 2024 to February 2025, followed by a reaudit of 500 vaginal births from February to May 2025, focusing on 14 cases of PPH >1000 ml (2.8%).

Results The initial audit revealed deficiencies in 56% of PPH records, including inadequate monitoring (35%), delayed uterotonic administration (15%), and delayed transfer from the postpartum ward to the emergency operating unit (59%). Post-intervention, documentation of informed choice improved (78% versus 49%), and significant PPH incidence decreased (2.8% versus 4%). Active third stage management increased (73% versus 27% physiological).

Conclusions The audit cycle reduced significant PPH through standardized protocols and team engagement, underscoring the value of continuous auditing in midwifery-led units.