Title: Developing a safety bundle to prevent postpartum haemorrhage in advanced labour caesarean section (C-Safe)
Funder: The Academy of Medical Sciences

Abstract: The aim of this research is to reduce haemorrhage at advanced labour caesarean section using a safety care bundle (C-Safe). We aim to develop this bundle, then test it on a small sample of women in order to refine the intervention prior to applying to full funding for a global trial. Caesarean section rates are on the rise globally; mothers who undergo the procedure in Low- and middle-income countries are 100 fold more likely to die than women from high-income countries. Caesarean sections performed in advanced labour significantly increased the risk of maternal death compared to those done in early labour by 12 fold, the leading cause being haemorrhage. Advanced labour caesarean sections are often done after a prolonged labour, increasing the risk of atonic haemorrhage. In addition, due to impaction of the fetal head and a thin stretched lower segment, difficult extraction of the head can lead to surgical trauma; uterine angle extensions and associated heavy bleeding. Even in high incomes countries haemorrhage is a leading cause of death. Components of our safety bundle will target these causes. Maternal complications can be prevented by anticipating potential intra-operative problems, readiness of the staff and resources, and standardising care â€“ both for prevention and management of complications. A bundle is a structured set of evidence-based practices, when performed collectively and reliably, improve patient outcomes. Through literature review, a Delphi process, surveys of healthcare workers and stake holders, we will develop a safety bundle targeting haemorrhage prevention for advanced labour caesarean sections.

Lay abstract: Our study will develop a safety care bundle to reduce bleeding in caesarean sections done in advanced labour. Caesarean sections are rising around the world, 1 in 10 are done in advanced labour, when the neck of the womb is nearly fully open - this is risky for mother and baby. For the mother, the biggest risk is bleeding. During advanced labour, part of the womb becomes thin and stretched with baby further down the birth canal. This makes it difficult for delivery of the babyâ€™s head from the birth canal through the incision in the abdomen, which may lead to tissues tearing and rapid bleeding. Often, there is additional blood loss, as the womb does not contract following a long labour. Our safety bundle will tackle these problems, it can include medication to help the uterus contract, or blood to clot, as well as a balloon device that helps with delivery of the babyâ€™s head- all of which have been shown to be reduce bleeding. Heavy bleeding is the leading causes of death in pregnancy around the world. A safety bundle is a structured set of practices based on evidence, when performed together, every time, improve patient outcomes. Complications can be prevented by predicting potential problems, and making sure that the staff, equipment and drugs needed to tackle them is available. After a series of discussions with experts and patients we will decide which interventions will form our safety bundle of care to reduce bleeding and test it.

Research activity codes: 7.1 INDIVIDUAL CARE NEEDS
Health categories: REPRODUCTIVE HEALTH AND CHILDBIRTH