Investigation and management of haemorrhagic disorders in pregnancy. Haemostasis and Thrombosis Task Force.

Introduction Bleeding and blood loss associated with pregnancy and delivery remain important causes of morbidity. Although catastrophic bleeding is fairly rare nowadays, haemorrhage, particularly after giving birth, is still one of the leading causes of maternal mortality.' Obstetric haemorrhage may be associated with specific complications of pregnancy or labour, or it may be due to an inherited or acquired bleeding diathesis. Obstetricians confronted with a patient who is bleeding, or who gives a personal or family history of bleeding or excessive bruising, should be alert to the possibility of an underlying inherited or acquired haemostatic defect. Each hospital should have a set of management guidelines for severe haemorrhage and must have 24 hour ready access to diagnostic laboratory facilities and advice from a designated haematologist. Although there are modern alternatives to blood, rapid access to blood and blood products is an absolute requirement for acceptable obstetric practice. Therefore, laboratory facilities for blood grouping and compatibility testing should be on site close to the maternity unit.