EU ropean P roject on obstetric H aemorrhage R eduction: A ttitudes, T rial, and E arly warning S ystem

1. EUropean Project on obstetric Haemorrhage Reduction: Attitudes, Trial, and Early warning System

2. POST PARTUM HAEMORRHAGEIn EUROPE • EUPHRATES Project • Funded by the European Union Quality of Life and Management of living Resources programme • Project Coordinator: • Sophie Alexander, Perinatal Epidemiology and Reproductive Health Unit, School of Public Health, Université Libre de Bruxelles, Belgium

3. EUPHRATES: Why? • Haemorrhage still one of the leading causes of maternal death in high, middle and low income countries • Haemorrhage still cause of severe morbidity in 1% of births in Europe (MOMS survey)

4. EUPHRATES: Where? • 14 of the original 15 EU countries: • - Austria - Italy • - Belgium - Netherlands • - Denmark - Norway • Finland - Portugal • France - Spain • Hungary - Switzerland • Ireland - Portugal

5. EUPHRATES: How? • Tackling the haemorrhage problem on various fronts • « 5workpackages » • Wp 1: European survey of policies regarding management of haemorrhage • Wp 2: Consensus statement • Wp 3: Trial of routine use of a collector sac • Wps 4&5: Websites

6. Workpackage 1 • A survey undertaken to describe current obstetric and midwifery policies related to the prevention and management of post-partum haemorrhage in the 14 participating countries of Europe. • hospital policies in 14 countries • home birth policies in 2 countries • It included questions about: definition of postpartum haemorrhage, management of the third stage of labour, measurement of blood loss and management of haemorrhage. In addition, questions were asked about the resources available in each maternity unit and about the level of activity in 2002. • Paper (1) to be submitted in March 2006 • Paper (2) to be submitted in May 2006

7. Workpackage 2 • The development of a minimal European core consensus on prevention and management of postpartum haemorrhage. • This consensus is not a protocol or guideline. It represents a European consensus on what could be agreed by all countries, while acknowledging that every maternity unit should have its own written protocol about the prevention and treatment of postpartum

8. Workpackage 2 (cont.) • Endorsement sought for consensus at country level by professional organisations: e.g. Ob-gyn, midwives, anaesthesiasts... • Paper has been written that will be submitted before the summer of 2006.

9. Workpackage 3 • Primary research • Use of a plastic collector bag for estimation of blood loss in the third stage of labour: a cluster randomised trial

10. Workpackage 3 (cont. 1) • Objective: to determine whether use of a transpartent plastic collector bag, by enhancing visual awareness of blood loss, will lead to more timely management, specifically when bleeding is excessive but before haemorrhage has become catastrophic, leading to a decrease in the incidence of severe post partum haemorrhage

11. Workpackage 3 (cont.2) • Methodology: 2-arm cluster randomised trial; 82 maternity units to be randomised and stratified by country and size of unit • Primary outcome: incidence (cases/vaginal birth) of severe PPH as measured by a composite marker, including one or more of the following; death from PPH, blood transfusion, use of intervenous plasma expander, admission to ICU, embolisation or other surgical treatment of PPH, treatment with recombinant factor VII • Secondary outcomes include: each of the individual components of primary outcome, Hb post partum, manual removal of placenta, use of prostaglandines

12. Workpackages 4 & 5 • Websites: • for professionals • for consumers • In progress

13. Summary of where we are • Wp1: Over 1000 maternity units surveyed and more than 400 midwifery practices (in UK and NL) surveyed. Papers to be submitted • Wp2: Consensus achieved, Endorsement in progress, to be published • Wp3: 3 countries have started, others in the starting blocks • Wps 4 & 5: Domains reserved, site 4 to be launched within a month, site 5 in progress