Reporting errors, incidence and risk factors for postpartum haemorrhage and progression to severe PPH: a prospective observational study. (12th February 2014)

• Record Type: Journal Article
• Authors: Briley, A; Seed, PT; Tydeman, G; Ballard, H; Waterstone, M; Sandall, J; Poston, L; Tribe, RM; Bewley, S
• Is Part Of: BJOG. Volume 121:Number 7(2014:Jul.)
• Page Start: 876
• Page End: 888
• Publication Date: 2014-02-12
• Subjects: Obstetrics -- Periodicals; Gynecology -- Periodicals; 618
• DOI: 10.1111/1471-0528.12588
• Languages: English
• ISSNs: 1470-0328

Abstract

<abstract abstract-type="main" id="bjo12588-abs-0001"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="bjo12588-sec-0001" sec-type="section"> <title>Objective</title> <p>To quantify reporting errors, measure incidence of postpartum haemorrhage (PPH) and define risk factors for PPH (≥500 ml) and progression to severe PPH (≥1500 ml).</p> </sec> <sec id="bjo12588-sec-0002" sec-type="section"> <title>Design</title> <p>Prospective observational study.</p> </sec> <sec id="bjo12588-sec-0003" sec-type="section"> <title>Setting</title> <p>Two UK maternity services.</p> </sec> <sec id="bjo12588-sec-0004" sec-type="section"> <title>Population</title> <p>Women giving birth between 1 August 2008 and 31 July 2009 (<italic>n</italic> = 10 213).</p> </sec> <sec id="bjo12588-sec-0005" sec-type="section"> <title>Methods</title> <p>Weighted sampling with sequential adjustment by multivariate analysis.</p> </sec> <sec id="bjo12588-sec-0006" sec-type="section"> <title>Main outcome measures</title> <p>Incidence and risk factors for PPH and progression to severe PPH.</p> </sec> <sec id="bjo12588-sec-0007" sec-type="section"> <title>Results</title> <p>Errors 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).</p> </sec> <sec id="bjo12588-sec-0008" sec-type="section"> <title>Conclusions</title> <p>Sequential, interacting, traditional and new risk factors explain the highest rates of PPH and severe PPH reported to date.</p> </sec> </abstract>