6 - Haemorrhage Then and Now

Summary

Haemorrhage is the leading global cause of maternal death. In the 1930s transfusion services were established in British cities, followed in 1946 by a national blood transfusion service. Drugs to cause uterine contraction were developed: ergometrine in the 1930s and oxytocin in the 1950s. In the 1930s obstetric flying squads were established, first in Bellshill and Newcastle, and in Birmingham by Hilda Lloyd, the first female RCOG president. They saved many lives but disappeared as home births fell. In the 1950s iron supplements were introduced into antenatal care to combat pre-existing anaemia. CEMD Reports highlighted the risk of vaginal examination in pregnancy. In the 1970s placental localisation by ultrasound became available. The Reports pointed out that intractable bleeding may need hysterectomy and the 1979-81 Report included the first guideline on emergency treatment of haemorrhage. Guidelines remain essential today, for example in planning care for women who refuse blood transfusion. Ectopic pregnancy can cause catastrophic bleeding in early pregnancy. The Reports showed that ethnic minorities are at higher risk and immediate surgery can be life-saving.