King's College London

Research portal

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

Research output: Contribution to journalArticle

A Briley, PT Seed, G Tydeman, H Ballard, M Waterstone, J Sandall, L Poston, RM Tribe, S Bewley

Original languageEnglish
Pages (from-to)876-888
Number of pages13
JournalBJOG: An International Journal of Obstetrics and Gynaecology
Issue number7
Publication statusPublished - Jun 2014

King's Authors


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).

Prospective observational study.

Two UK maternity services.

Women giving birth between 1 August 2008 and 31 July 2009 (n = 10 213).

Weighted sampling with sequential adjustment by multivariate analysis.

Main outcome measures
Incidence and risk factors for PPH and progression to severe PPH.

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).

Sequential, interacting, traditional and new risk factors explain the highest rates of PPH and severe PPH reported to date.

View graph of relations

© 2018 King's College London | Strand | London WC2R 2LS | England | United Kingdom | Tel +44 (0)20 7836 5454