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UK-wide trial to reduce bleeding after childbirth

6 June 2023

A treatment strategy developed in Wales to help reduce excessive bleeding after childbirth is being expanded into maternity units across Scotland, England and Northern Ireland as part of a major trial.

The OBS UK trial aims to improve the quality of care for mothers and babies with a special focus on differences in care and outcomes for women of diverse ethnicities and backgrounds.

It is being led by academics at Cardiff University’s School of Medicine and Cardiff and Vale University Health Board and will be co-ordinated by the University’s Centre for Trials Research.

OBS UK – which is funded by the National Institute for Heath and Care Research (NIHR) -builds on the success of the Obstetric Bleeding Strategy Cymru (OBS Cymru) - a national quality improvement programme developed by researcher in Cardiff that has seen a 29% reduction in massive postpartum haemorrhage and 160 women per year avoiding the need for a blood transfusion after birth.

Now, with a £3.65 million grant from the NIHR, the strategy will be trialled in 36 hospital sites across the UK and aims to prevent nearly 2,000 women each year from needing a blood transfusion.

Professor Peter Collins, of Cardiff University’s School of Medicine, who developed OBS Cymru and will jointly lead the new trial said: “Excess bleeding is the most common complication of childbirth, with about 50,000 women each year in the UK losing one litre of blood or more after birth. Many women who need a blood transfusion after blood loss, are admitted to intensive care, and develop post-traumatic stress disorder due to excess bleeding. Some women develop abnormal clotting which makes the bleeding worse. Part of the treatment strategy identifies women during the bleeding that have blood that does not clot properly. This means that the right treatment is given rapidly to the women who need it.”

The OBS Cymru programme launched in Wales in 2016 to address the lack of knowledge in treating excess bleeding after childbirth, to improve and standardise maternity care and address racial disparities. It introduced a process for identifying women who are at high risk of bleeding, methods for early recognition and treatment of abnormal bleeding, and the identification of and early intervention for abnormalities in blood clotting.

Dr Sarah Bell, Consultant Anaesthetist, Cardiff and Vale University Health Board and who was part of the OBS Cymru strategy team and will jointly lead OBS UK said: “The Obstetric Bleeding Strategy allows clinical teams to identify when bleeding is abnormal and work together to stop it quickly. When we rolled this out to Welsh maternity units we saw a significant fall in large bleeds and the number of blood transfusions needed.”

One of the aims of OBS UK is to examine excessive bleeding in relation to race, ethnicity and other elements of social diversity.

Dr Julia Townson, Cardiff University’s Centre for Trials research said: “Ensuring that the experiences of minority groups are included in this research is a major priority for the whole research team. As well as drawing on the personal experiences of individuals from minority groups, we will work with Egality Health, a community engagement agency focusing on improving inclusivity in health research.”

Julia Sanders, Professor of Nursing and Clinical Midwifery at Cardiff University’s School of Healthcare Sciences who will work on the OBS UK trial added: “Reducing excess childbirth bleeding is important. For too many women just when they need to be feeling well to care for their baby, the excess bleeding they experienced during birth means they are tired and unwell. OBS Cymru is a fantastic example of what can be achieved when midwives, obstetricians, anaesthetists and other experts work together to make maternity care safer. It is a real achievement that so many women in Wales have already benefited.  We are all looking forward to working with teams from across the rest of the UK as they roll out OBS UK into their maternity services.”

The UK-wide trial starts in May 2023 and will be rolled out to 190,000 women over 30 months.

The trial will operate in collaboration between Cardiff University, University of Oxford, Liverpool University, Swansea University, Aberdeen University, Shrewsbury and Telford NHS Trust, Keele University, Cardiff and Vale University Health Board and Egality Health.

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