Background and Goal of Study: First line surgical treatment for postpartum haemorrhage
(PPH) following vaginal delivery is manual emptying of the uterine cavity. Anaesthesia is
provided as regional anaesthesia (spinal/epidural) or general anaesthesia. Method depends on
airway risk assessment, circulatory instability due to haemorrhage, and local tradition. We aim
to describe the Danish national variation in choice of anaesthesia for PPH. We hypothesized
that small centres with few annual deliveries were more likely to choose general anaesthesia.
Materials and Methods: Using the National Danish Patient Register we defined our population
by the SKSprocedure codes KMBA10,30,30A: manual removal of placenta, placental parts or
manual exploration of the uterus due to continuous bleeding after placental delivery performed
during 2010 to 2015. The Danish Anaesthesia Database (DAD) contains information on mode
of anaesthesia. A merge between the two registries was performed. Logistic regression was
used (p<0.001).
Results and Discussion: Denmark had a total of 11,053 PPH treatment procedures in 27
different centres complicating 3% of deliveries during 2010 to 2015. Three centres did not report
to DAD and some centres did not report or exist during the entire period. Mode of anaesthesia
was obtained for 5,750 (52%) procedures. We found a significant increase in the use of
regional anaesthesia during the period and a corresponding decrease in the use of general
anaesthesia. Small centres had a significantly higher proportion of patients receiving general
anaesthesia. Large centres had a significantly higher proportion receiving regional
anaesthesia. We found no difference in the proportion of deliveries complicated by PPH
treatment procedures between centres or during the period. Regional anaesthesia is
increasingly being used in the treatment of PPH. This tendency follows the recommendation for
caesarean section due to increased risk related to tracheal intubation. However, regional
anaesthesia may cause circulatory collapse with severe haemorrhage. Thus, the higher
proportion of patients receiving general anaesthesia in small centres could suggest that
inexperience at the initial circulatory assessment prompts more patients to be given general
anaesthesia.
Conclusion(s): Small delivery centres are more likely to choose general anaesthesia for PPH
treatment procedures.

02 / General or regional anaesthesia for postpartum haemorrhage