Increased postpartum hemorrhage rates in Australia

Ford, Jane B.; Roberts, Christine L.; Simpson, Judy M.; Vaughan, Janet; Cameron, Carolyn A.

doi:10.1016/j.ijgo.2007.03.011

Cited by 179 publications

(169 citation statements)

References 18 publications

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“…This study demonstrated that dichotomising perinatal outcome data into categories that are typically reported in population health research 5,6 resulted in high levels of ascertainment and accuracy. With all sensitivities $94.7% and all PPVs $96.1%, reassurance is provided for the use of these data items in their dichotomised form where necessary for comparison to other findings or due to sample size constraints.…”

Section: Discussionmentioning

confidence: 87%

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Are pregnancy outcomes associated with risk factor reporting in routinely collected perinatal data?

Ampt¹,

Ford²,

Taylor³

et al. 2013

NSW Public Health Bull.

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Aim:To assess reporting characteristics of commonly dichotomised pregnancy outcomes (e.g. preterm/term birth); and to investigate whether behaviours (e.g. smoking), medical conditions (e.g. diabetes) or interventions (e.g. induction) were reported differently by pregnancy outcomes. Methods: Further analysis of a previous validation study was undertaken, in which 1680 perinatal records were compared with data extracted from medical records. Continuous and polytomous variables were dichotomised, and risk factor reporting was assessed within the dichotomised outcome groups. Agreement, kappa, sensitivity and positive predictive value calculations were undertaken. Results: Gestational age, birthweight, Apgar scores, perineal trauma, regional analgesia and baby discharge status (live birth/ stillbirth) were reported with high accuracy and reliability when dichotomised (kappa values 0.95-1.00, sensitivities 94.7-100.0%). Although not statistically significant, there were trends for hypertension, infant resuscitation and instrumental birth to be more accurately reported among births with adverse outcomes. In contrast, smoking ascertainment tended to be poorer among preterm births and when babies were ,2500 g. Conclusion: Dichotomising variables collected as continuous or polytomous variables in birth data results in accurate and well ascertained data items. There is no evidence of systematic differential reporting of risk factors.Population level data are well suited to studies evaluating health care. With the risk of sampling bias removed, estimation of incidence and prevalence rates can be made, allowing for description of the total burden of a particular disease or outcome, analysis of risk factors and trends, as well as identification of health inequalities and estimation of health costs. 1,2 Accurate conclusions from such analyses rely on high quality data that truly represent the population experience. Assessment of data quality (completeness and accuracy) is typically undertaken by a validation study, in which data from a sample of records from the population dataset are compared to a highly reliable and accurate source of data ('the gold standard') for the corresponding records. The accuracy and reliability of individual data items are typically reported. 3,4 The variables in perinatal population data can be continuous (e.g. gestational age), nominal (e.g. mode of delivery) and ordinal (e.g. first, second, third or fourth degree perineal tears), with validation of such variables typically reporting percent agreement and kappa statistics. These types of variables are frequently dichotomised in analyses (e.g. preterm birth, caesarean section, or third-fourth degree tears), 5,6 but little assessment has been undertaken into the accuracy and reliability of their dichotomised form.Differential reporting in population health data occurs when a variable is reported with different accuracy and reliability amongst different strata of another variable. This can introduce systematic bias, leading to under or over...

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Section: Discussionmentioning

confidence: 87%

“…These types of variables are frequently dichotomised in analyses (e.g. preterm birth, caesarean section, or third-fourth degree tears), 5,6 but little assessment has been undertaken into the accuracy and reliability of their dichotomised form.…”

mentioning

confidence: 99%

Are pregnancy outcomes associated with risk factor reporting in routinely collected perinatal data?

Ampt¹,

Ford²,

Taylor³

et al. 2013

NSW Public Health Bull.

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“…However, identification of women with iron deficiency anemia has low sensitivity (5.7-12.0%) (19) and so this was excluded from the final model. Another possible reason for the increase in transfusion is the recent increase in PPH, which has been observed both in NSW (24) and overseas. (6,8,11,12) As the majority of transfusions are performed in admissions with a diagnosis of hemorrhage, an increase in PPH would likely lead to an increase in blood transfusions, as has been observed elsewhere.…”

Section: Methodsmentioning

confidence: 99%

Blood Transfusion During Pregnancy, Birth, and the Postnatal Period

Patterson¹,

Roberts

Bowen

et al. 2014

Obstetric Anesthesia Digest

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Precis: Obstetric blood transfusions continue to increase, with most of these occurring in the birth admission in association with hemorrhage.Objectives: To identify trends in transfusion rates across pregnancy and the postnatal period, and identify risk factors for transfusion. 81% of these transfusions were associated with a diagnosis of hemorrhage. Women with bleeding/platelet disorders(vaginal RR= 7.8, CI 7.1-8.5, cesarean RR 8.7, CI 7.9-9.5) and placenta previa(vaginal RR=4.6, CI 3.7-5.8, cesarean 5.7, CI 5.2-6.2), were at highest risk of transfusion. Among vaginal births, increased risk was evident for forceps (RR=2.8, CI 2.6-3.0) or vacuum births (RR=1.9, CI 1.7-2.0) compared with non-operative births. Methods Conclusions:Rates of obstetric blood product transfusion have increased by 33% since 2001, with the majority of this associated with hemorrhage. Women with bleeding/platelet disorders and placenta previa are at increased risk of transfusion, and should be managed accordingly.

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“…Recent reports indicate that the incidence of postpartum hemorrhage (PPH) is increasing worldwide [2][3][4][5][6][7][8][9][10][11][12][13]. The physical impact of MOH has been studied extensively [14]; however hardly any data are available on psychological consequences.…”

Section: Introductionmentioning

confidence: 99%

Major obstetric hemorrhage: a follow-up survey on quality of life of women and their partners

Stralen

Ruijten

Kaptein

et al. 2017

Journal of Psychosomatic Obstetrics & Gynecology

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Introduction: A description is given of the quality of life (QOL) of women who were treated with peripartum embolization or hysterectomy for major obstetric hemorrhage (MOH). Methods: Questionnaires assessing QOL, combined with questionnaires and drawings assessing illness perceptions, were used to compare women with MOH to reference groups provided by the questionnaires. Results: Women who experienced MOH have similar scores on QOL questionnaires compared to reference groups. Women treated with arterial embolization scored better than women treated with hysterectomy. Partners of women with MOH scored better on QOL questionnaires than reference groups. Drawings reflect the major emotional impact of MOH. Discussion: MOH does not seem to have a negative effect on QOL 6-8 years after the event, although drawings and verbalizations indicate major emotional impact. More extensive follow-up is advised for early recognition of the need for psychological help. Women after embolization seem to have better QOL compared to women after hysterectomy.

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Increased postpartum hemorrhage rates in Australia

Abstract: Increases in postpartum hemorrhage are not explained by the changing risk profile of women. It may be that changes in management and/or reporting of postpartum hemorrhage have resulted in higher postpartum hemorrhage rates.

Cited by 179 publications

References 18 publications

Are pregnancy outcomes associated with risk factor reporting in routinely collected perinatal data?

Are pregnancy outcomes associated with risk factor reporting in routinely collected perinatal data?

Blood Transfusion During Pregnancy, Birth, and the Postnatal Period

Major obstetric hemorrhage: a follow-up survey on quality of life of women and their partners

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