Timely and universal activation of the 2222 major obstetric haemorrhage call at the Royal London Hospital

Abstract

Introduction: Obstetric haemorrhage remains one the major causes of maternal death across the globe. Prompt recognition and MDT management are vital to reduce morbidity and mortality of mother and baby; 2222 Major Obstetric Haemorrhage (MOH) calls to activate relevant team members are a key step in achieving this. Clinical case reviews of MOH at the Royal London Hospital found that 2222 MOH Calls were regularly not appropriately activated. The aim of this project was to mandate immediate activation of the 2222 Major Obstetric Haemorrhage Call at an estimated blood loss (EBL) of >=1500 ml and/or with signs of haemodynamic compromise, in line with both trust and national guidelines.1 We also sought to remove the 'controlled MOH' call, which we felt was ambiguous and could lead to a delay in MDT assistance. Method(s): An initial audit of deliveries between February and May 2025 was performed. The number of 2222 MOH calls to switchboard and the number of deliveries with a documented EBL >=1500 ml as logged on the electronic patient record were recorded. Several interventions were subsequently carried out - presentation in the Obstetric Peri-partum Care Forum, education in the daily MDT handover safety briefings, MOH call posters were displayed on obstetric wards, and the trust MOH guidelines were revised. A re-audit was performed of deliveries from September to December 2025. The number of 'controlled MOH' calls logged was noted for each period. Result(s): In the period prior to intervention February - May 2025 there were 78 documented MOH cases and a total of 61 documented 2222 MOH calls. During September - December 2025 (after interventions), 71 documented MOH cases occurred with a total of 79 logged 2222 MOH calls. In the four month period pre-intervention there were 18 'controlled MOH' calls logged; after intervention there were 6. Discussion(s): Before intervention, fewer MOH calls than documented haemorrhages suggested under-utilisation of the 2222 MOH call. Post-intervention, the higher number of MOH calls relative to documented cases indicates more proactive and appropriate escalation. The marked reduction in 'controlled MOH' calls supports improved clarity around escalation pathways. While direct clinical outcomes were not assessed, timely MDT involvement is likely to have positively influenced patient care and safety in this high-risk. [Formula presented] Copyright © 2026