Abstract
Objective 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).
Design Prospective observational study.
Setting Two UK maternity services.
Population Women giving birth between 1 August 2008 and 31
July 2009 (n = 10 213).
Methods Weighted sampling with sequential adjustment by
multivariate analysis.
Main outcome measures Incidence and risk factors for PPH and
progression to severe PPH.
Results 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).
Conclusions Sequential, interacting, traditional and new risk
factors explain the highest rates of PPH and severe PPH reported
to date.
postpartum haemorrhage (PPH) and define risk factors for PPH
(≥500 ml) and progression to severe PPH (≥1500 ml).
Design Prospective observational study.
Setting Two UK maternity services.
Population Women giving birth between 1 August 2008 and 31
July 2009 (n = 10 213).
Methods Weighted sampling with sequential adjustment by
multivariate analysis.
Main outcome measures Incidence and risk factors for PPH and
progression to severe PPH.
Results 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).
Conclusions Sequential, interacting, traditional and new risk
factors explain the highest rates of PPH and severe PPH reported
to date.
| Original language | English |
|---|---|
| Pages (from-to) | 876-888 |
| Number of pages | 13 |
| Journal | BJOG: An International Journal of Obstetrics and Gynaecology |
| Volume | 121 |
| DOIs | |
| Publication status | Published - 2014 |
Keywords
- Blood Loss, Surgical/prevention & control
- observational study
- severe adverse maternal morbidity
- pregnancy progression
- risk factors