References
Reducing the risk of postpartum haemorrhage in paramedic practice
Abstract
Primary postpartum haemorrhage is the most common form of obstetric haemorrhage. Poor recognition and treatment of this condition has been linked to cases of mortality in recent years. Greater choice over birth settings for mothers and a national shortage of midwives are likely to result in more frequent exposure to maternity cases for paramedics in future years. Active management of the third stage of labour reduces the risks of primary postpartum haemorrhage and shortens the length of the third stage of labour. UK ambulance service guidelines are currently based upon physiological management of the third stage of labour, so in the absence of a midwife, paramedics cannot actively manage the third stage. Paramedic training has moved to higher education university programmes in recent years and undergraduate paramedic students receive additional training about the management of obstetric emergencies. This article discusses current clinical practice and recommends that paramedics adopt active management of the third stage of labour, in order to reduce the risk of primary postpartum haemorrhage. In addition, the author asks whether current paramedic practice is effective in treating primary postpartum haemorrhage within the pre-hospital setting, when a midwife is not present at the scene.
Primary postpartum haemorrhage (PPH) is the most common form of obstetric haemorrhage (Royal College of Obstetricians and Gynaecologists (RCOG, 2009). The causes of PPH are referred to as the ‘four T's’ (RCOG, 2009): Tone (abnormalities of uterine contraction), Tissue (retained products of conception), Trauma of the genital tract, and Thrombin (abnormalities of coagulation). Failure of the uterus to contract after the second stage of labour (atonicity) is the most common cause of PPH (Matthews et al, 2007). RCOG (2009) state ‘the majority of maternal deaths due to haemorrhage must be considered preventable’, based on evidence from the report WhyMothersDie (Confdential Enquiry into Maternal and Child Health (CEMACH), 2004). Founded over 50 years ago, CEMACH aims to reduce the instances of maternal death in the (UK. Confdential enquiries into maternal deaths and the triennial publication of key fndings and recommendations by CEMACH enable clinicians and NHS Trusts to improve maternity practice (Lewis, 2007). Although maternal death is increasingly rare in the UK, research suggests that mortality directly related to pregnancy has increased in recent years (Lewis, 2007). Therefore it is important that paramedics are adequately trained in the effective treatment and prevention of PPH.
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