Incidence, trends and severity of primary postpartum haemorrhage in Australia: A population‐based study using Victorian Perinatal Data Collection data for 764 244 births

Flood, Margaret; McDonald, Susan; Pollock, Wendy; Cullinane, Fiona; Davey, Mary‐Ann

doi:10.1111/ajo.12826

Cited by 26 publications

(38 citation statements)

References 26 publications

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“…These figures are at least 50% lower than the incidence of 30.9-40.7% observed in Wales in 2017 where quantitative measurement was started at delivery and the same method, confirmed by audit, was used throughout the country. In the context of clinical studies performed more recently, a UK group reported the incidence of PPH ≥500 mL to be 33.7% [11] and in Australia 22% [6] which are in line with our findings established in routine care.…”

Section: Discussionsupporting

confidence: 92%

“…It is reported that blood loss measurement alone does not reduce PPH rates [6,14]. A cluster randomised study comparing systematic use of a collector bag with visual estimation found no difference between the two arms [32].…”

Section: Discussionmentioning

confidence: 99%

“…In the UK, postpartum haemorrhage (PPH) is defined by The Royal College of Obstetrics and Gynaecology (RCOG) as minor for bleeds between 500 and 1000 mL, moderate > 1000-2000 mL and severe > 2000 mL [1,2]. Other groups define PPH > 1000 mL as severe [3][4][5][6] and a core outcome set, based on an expert consensus and Delphi analysis, recommended the use of ≥1000 mL as a key outcome measure for treatment and prevention of PPH [7]. Current PPH management guidelines advocate escalation of care to more senior staff based on specific volumes of blood loss, rate of bleeding and patient's vital signs [1,8,9].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Incidence of postpartum haemorrhage defined by quantitative blood loss measurement: a national cohort

Bell

Watkins

John

et al. 2020

BMC Pregnancy Childbirth

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Background: Visual estimation of blood loss following delivery often under-reports actual bleed volume. To improve accuracy, quantitative blood loss measurement was introduced for all births in the 12 hospitals providing maternity care in Wales. This intervention was incorporated into a quality improvement programme (Obstetric Bleeding Strategy for Wales, OBS Cymru). We report the incidence of postpartum haemorrhage in Wales over a 1year period using quantitative measurement. Methods: This prospective, consecutive cohort included all 31,341 women giving birth in Wales in 2017. Standardised training was cascaded to maternity staff in all 12 hospitals in Wales. The training comprised mockscenarios, a video and team drills. Uptake of quantitative blood loss measurement was audited at each centre. Data on postpartum haemorrhage of > 1000 mL were collected and analysed according to mode of delivery. Data on blood loss for all maternities was from the NHS Wales Informatics Service. Results: Biannual audit data demonstrated an increase in quantitative measurement from 52.1 to 87.8% (P < 0.001). The incidence (95% confidence intervals, CI) of postpartum haemorrhage of > 1000 mL, > 1500 mL and > 2000 mL was 8.6% (8.3 to 8.9), 3.3% (3.1 to 3.5) and 1.3% (1.2 to 1.4), respectively compared to 5%, 2% and 0.8% in the year before OBS Cymru. The incidence (95% CI) of bleeds of > 1000 mL was similar across the 12 hospitals despite widely varied size, staffing levels and case mix, median (25th to 75th centile) 8.6% (7.8-9.6). The incidence of PPH varied with mode of delivery and was mean (95% CI) 4.9% (4.6-5.2) for unassisted vaginal deliveries, 18.4 (17.1-19.8) for instrumental vaginal deliveries, 8.5 (7.7-9.4) for elective caesarean section and 19.8 (18.6-21.0) for non-elective caesarean sections. Conclusions: Quantitative measurement of blood loss is feasible in all hospitals providing maternity care and is associated with detection of higher rates of postpartum haemorrhage. These results have implications for the definition of abnormal blood loss after childbirth and for management and research of postpartum haemorrhage.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Incidence of postpartum haemorrhage defined by quantitative blood loss measurement: a national cohort

Bell

Watkins

John

et al. 2020

BMC Pregnancy Childbirth

View full text Add to dashboard Cite

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“…This study demonstrates the persistent increasing rate of PPH and MOH in Ireland in keeping with other studies. (9,11,12) As in other studies (13) we found uterine atony to be the most common cause of MOH. Identifying a cause(s) for this trend is difficult.…”

Section: Principal Findingssupporting

confidence: 83%

Major obstetric haemorrhage: Incidence, management and quality of care in Irish maternity units

Greene

McKernan

Manning

et al. 2021

European Journal of Obstetrics & Gynecology and Reproductiv

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“…Therefore our results can only be applied to women with a PPH less than 1500 mL blood loss, which is the majority of all women experiencing PPH. Of all women in labor, 1.4–3.9% progress to more than 1500 mL blood loss [ 3 , 42 ]. Another safety measure was the choice to commence resuscitation at 500 mL of blood loss.…”

Section: Resultsmentioning

confidence: 99%

Restrictive versus liberal fluid resuscitation strategy, influence on blood loss and hemostatic parameters in mild obstetric hemorrhage: An open-label randomized controlled trial. (REFILL study)

et al. 2021

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Background Evidence for optimal hemostatic resuscitation in postpartum hemorrhage (PPH) is lacking. Liberal fluid administration may result in acidosis, hypothermia and coagulopathy. Objective We hypothesize that in early PPH a restrictive fluid administration results in less progression to moderate PPH. Study design In four Dutch hospitals we recruited women of 18 years and over, and more than 24 weeks pregnant. Exclusion criteria were: anticoagulant therapy, known coagulation disorders, pre-eclampsia, antenatal diagnosis of abnormally adhesive placenta, and a contraindication for liberal fluid therapy. We blindly randomized participants at 500 mL and ongoing blood loss in the third stage of labor between restrictive fluid administration (clear fluids 0.75–1.0 times the volume of blood lost) and liberal fluid administration (clear fluids 1.5–2.0 times the volume of blood lost). The primary outcome was progression to more than 1000 mL blood loss. Analyses were according to the intention-to-treat principle. Results From August 2014 till September 2019, 5190 women were informed of whom 1622 agreed to participate. A total of 252 women were randomized of which 130 were assigned to the restrictive group and 122 to the liberal group. In the restrictive management group 51 of the 130 patients (39.2%) progressed to more than 1000 mL blood loss versus 61 of the 119 patients (51.3%) in the liberal management group (difference, -12.0% [95%-CI -24.3% to 0.3%], p = 0.057). There was no difference in the need for blood transfusion, coagulation parameters, or in adverse events between the groups. Conclusions Although a restrictive fluid resuscitation in women with mild PPH could not been proven to be superior, it does not increase the need for blood transfusion, alter coagulation parameters, or cause a rise in adverse events. It can be considered as an alternative treatment option to liberal fluid resuscitation. Trial registration NTR3789.

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Incidence, trends and severity of primary postpartum haemorrhage in Australia: A population‐based study using Victorian Perinatal Data Collection data for 764 244 births

Abstract: The incidence of primary postpartum haemorrhage, severe primary postpartum haemorrhage and associated maternal morbidities have increased significantly over time in Victoria.

Cited by 26 publications

References 26 publications

Incidence of postpartum haemorrhage defined by quantitative blood loss measurement: a national cohort

Incidence of postpartum haemorrhage defined by quantitative blood loss measurement: a national cohort

Major obstetric haemorrhage: Incidence, management and quality of care in Irish maternity units

Restrictive versus liberal fluid resuscitation strategy, influence on blood loss and hemostatic parameters in mild obstetric hemorrhage: An open-label randomized controlled trial. (REFILL study)

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