Reporting errors, incidence and risk factors for postpartum haemorrhage and progression to severe PPH: a prospective observational study

Abstract

ObjectiveTo quantify reporting errors, measure incidence of postpartum haemorrhage (PPH) and define risk factors for PPH (≥500 ml) and progression to severe PPH (≥1500 ml).DesignProspective observational study.SettingTwo UK maternity services.PopulationWomen giving birth between 1 August 2008 and 31 July 2009 (n = 10 213).MethodsWeighted sampling with sequential adjustment by multivariate analysis.Main outcome measuresIncidence and risk factors for PPH and progression to severe PPH.ResultsErrors in transcribing blood volume were frequent (14%) with evidence of threshold preference and avoidance. The incidences of PPH ≥500, ≥1500 and ≥2500 ml were 33.7% (95% CI 31.2–36.2), 3.9% (95% CI 3.3–4.6) and 0.8% (95% CI 0.6–1.0). New independent risk factors predicting PPH ≥ 500 ml included Black African ethnicity (adjusted odds ratio [aOR] 1.77, 95% CI 1.31–2.39) and assisted conception (aOR 2.93, 95% CI 1.30–6.59). Modelling demonstrated how prepregnancy- and pregnancy-acquired factors may be mediated through intrapartum events, including caesarean section, elective (aOR 24.4, 95% CI 5.53–108.00) or emergency (aOR 40.5, 95% CI 16.30–101.00), and retained placenta (aOR 21.3, 95% CI 8.31–54.7). New risk factors were identified for progression to severe PPH, including index of multiple deprivation (education, skills and training) (aOR 1.75, 95% CI 1.11–2.74), multiparity without caesarean section (aOR 1.65, 95% CI 1.20–2.28) and administration of steroids for fetal reasons (aOR 2.00, 95% CI 1.24–3.22).ConclusionsSequential, interacting, traditional and new risk factors explain the highest rates of PPH and severe PPH reported to date.

Shock index: an effective predictor of outcome in postpartum haemorrhage?

“…Data from a large prospective observational study of women with PPH over a 1-year period (women giving birth between 1 August 2008 and 31 July 2009) at a UK tertiary referral centre were used to identify all women with blood loss of 1500 ml or more, 34 as approved by the South East multicentre research ethics committee. All BP and HR values recorded within the first hour following recognition of PPH were included in the analysis (measured using the BP devices available on the wards).…”

Transcatheter Arterial Embolization for Postpartum Hemorrhage: Indications, Technique, Results, and Complications

“…PPH is defined as a blood loss [500 mL within 24 h after vaginal delivery and [1,000 mL in case of cesarean delivery [1][2][3][4]33]. Severe PPH is defined as a life-threatening blood loss with hemodynamic consequences that need unusual therapy [1][2][3][4]14]. PPH and severe PPH represent 6 and 1.86 % of all deliveries, respectively [3].…”

“…Acknowledged risk factors for PPH include high parity, fetomaternal dystocia, multifetal pregnancy, hydramnios, uterine leiomyoma, abnormal placentation, and prior history of PPH [2,4,[38][39][40]. However, most women with PPH have no risk factors so that the occurrence of PPH is hardly predictable [38].…”

“…In developed countries, the frequency of emergency peripartum hysterectomy was around 1/1,000 deliveries in 1990 and dropped to 1/2,000 deliveries in 2010 [3]. This substantial drop is presumably due to early identification of PPH with appropriate initial measures, marked improvements in medical resuscitation, and an increased use of conservative treatments including pelvic artery ligation, uterine compression sutures, balloon tamponade, and percutaneous transcatheter arterial embolization (TAE) [4][5][6][7][8][9][10].…”

Research of the assessable method of postpartum hemorrhage

“…Because of the sudden and rapid onset of PPH, earlier identification of risk factors may allow doctors to enact appropriate measures to reduce risk. Uterine inertia is the most common cause of PPH, accounting for 70%∼75% of reported cases [7][8][9][10][11]. This study analyzed, evaluated and predicted the risk of PPH from three perspectives: epidemiological, placental, and biochemical.…”