OAA Medium Project Grant
Characterising the coagulopathy of postpartum haemorrhage (PPH)
Dr Rachel Collis
Background
Severe bleeding is the most common cause of major problems at the time of childbirth and affects over 10,000 women every year in the UK. Bleeding may be made worse if the blood clotting system is affected and the blood becomes too thin. There is a lot of information about how major trauma can make the blood too thin and how this should be treated. There is very little information about how bleeding at the time of childbirth makes the blood too thin. Also, it is very likely that the specific cause of the bleeding will make the blood thin in different ways. Because there is so little information about how the blood clots during bleeding after childbirth, women are usually treated in the same way as people who have had major trauma. This is unlikely to be the best treatment and may even cause harm because some women may be given treatment unnecessarily.
Aims of study
We plan to use specialised tests to look in detail at the blood clotting system of women who are experiencing bleeding at the time of childbirth. We will compare the results with women who are having babies but are not bleeding. We will look at whether the specific cause of the bleeding affects the blood clotting system differently and also how the changes in blood clotting evolve if bleeds continue and routine treatment is given. We will also look at what effect treatment designed to thicken the blood has on the blood clotting system to see whether it is working as expected.
Study
Women who are having moderate or severe bleeding can be involved in the study. All women who are bleeding after childbirth have routine blood clotting tests done. If bleeding continues, these tests are repeated roughly every 30 minutes. We plan to take extra blood at the time of the routine blood clotting tests and use it to perform specialised tests of the blood clotting system. The specialist tests will see whether specific clotting factors are working normally and whether any changes have happened that inhibit blood clotting or break down clots more quickly than normal. If any treatment is given to thicken the blood we will check the specialist tests after the treatment to see what effect it has had.
Outcome of the study
The information from the study will show how the blood clotting system if affected by bleeding after childbirth. It will help us to work out how best to support the blood clotting system of women who are bleeding at the time of childbirth and to stop the bleeding sooner.
