Investigation of an increase in postpartum haemorrhage in Canada

Joseph, K. S.; Rouleau, Jocelyn; Kramer, Michael S.; Young, David; Liston, Robert; Baskett, Thomas F.

doi:10.1111/j.1471-0528.2007.01316.x

Cited by 265 publications

(246 citation statements)

References 17 publications

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“…Medical record data from our study indicated that uterine atony is the primary cause of between 35-40% of postpartum hemorrhage cases whereas population data reporting, based on the ICD code to which atony is assigned, indicated that uterine atony was the cause of 75-80% of postpartum hemorrhages. While other studies have reported on atonic hemorrhage using specific hemorrhage categories within the broader postpartum hemorrhage ICD code, 13,21 the results of our study indicate misclassification is present among these specific subcodes. This is consistent with other diagnoses such as hypertension and diabetes where broader categories are more reliably reported than specific sub-categories.…”

Section: Discussioncontrasting

confidence: 89%

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Hospital Data Reporting on Postpartum Hemorrhage: Under-Estimates Recurrence and Over-Estimates the Contribution of Uterine Atony

Ford

Algert

Kok

et al. 2011

Matern Child Health J

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(250 words)Objectives: This study aimed to explore whether recording of a prior adverse pregnancy outcome in a medical record increases the likelihood that recurrence of the same event is reported in population data. Methods:Using a random sample of 294 women who had first and second pregnancies in NSW, and a postpartum hemorrhage (PPH) reported for at least one pregnancy, we compared 'coded' recurrence rates in hospital data with those obtained from medical record audit. 'Coded' recurrence in a second pregnancy was also compared for women with or without a documented history of prior PPH. Results:We found a 'coded' recurrence rate of 18.5% and a 'true' rate (according to medical record audit) of 28.4%. The 'coded' rate of recurrence among women who had a documented history of PPH was 27.4% compared to 19.1% among those where the previous PPH was not noted in the second pregnancy medical record. 'True' reporting of a uterine atony cause for postpartum hemorrhages in first and second births was 37.9% and 34.0% while 'coded' hospital data reporting was 79.8% and 73.9% respectively. Conclusions:Our study results indicate that a history of postpartum hemorrhage may be an even stronger risk factor for subsequent PPH than previously demonstrated. A recorded history of PPH was associated with a higher likelihood of reporting a subsequent PPH, however in such cases recurrence rates approximate true recurrence. The contribution of uterine atony as a cause of postpartum hemorrhage is over-estimated using population health data.

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Section: Discussioncontrasting

confidence: 89%

“…11 Recent studies have used population health data to ascertain uterine atony, 12,13 however the validity of hospital data for reporting uterine atony has not been established.…”

Section: Introductionmentioning

confidence: 99%

Hospital Data Reporting on Postpartum Hemorrhage: Under-Estimates Recurrence and Over-Estimates the Contribution of Uterine Atony

Ford

Algert

Kok

et al. 2011

Matern Child Health J

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“…[5][6][7][8][9][10][11][12][13] Recent studies demonstrate an increase in severe maternal morbidity in Western countries, possibly due to changes in management of obstetric complications and increasing age of pregnant women. 2,14,15 A nationwide cohort study of severe maternal morbidity, called LEMMoN, was conducted in the Netherlands to assess incidence, case fatality rates, risk factors and substandard care overall for different subgroups. As ethnicity appeared to be a significant risk factor for pregnancy-related death 2,16,17 and seemed to be a risk factor for severe maternal morbidity, we are especially interested in the association of ethnicity with severe maternal morbidity.…”

Section: Introductionmentioning

confidence: 99%

Severe maternal morbidity during pregnancy, delivery and puerperium in the Netherlands: a nationwide population‐based study of 371 000 pregnancies

Zwart

Richters

Öry³

et al. 2008

BJOG

313

163

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Objective To assess incidence, case fatality rate, risk factors and substandard care in severe maternal morbidity in the Netherlands.Design Prospective population-based cohort study.Setting All 98 maternity units in the Netherlands.Population All pregnant women in the Netherlands.Methods Cases of severe maternal morbidity were collected during a 2-year period. All pregnant women in the Netherlands in the same period acted as reference cohort (n = 371 021). As immigrant women are disproportionately represented in Dutch maternal mortality statistics, special attention was paid to the ethnic background. In a subset of 2.5% of women, substandard care was assessed through clinical audit.Main outcome measures Incidence, case fatality rates, possible risk factors and substandard care.Results Severe maternal morbidity was reported in 2552 women, giving an overall incidence of 7.1 per 1000 deliveries. Intensive care unit admission was reported in 847 women (incidence 2.4 per 1000), uterine rupture in 218 women (incidence 6.1/10 000), eclampsia in 222 women (incidence 6.2/10 000) and major obstetric haemorrhage in 1606 women (incidence 4.5 per 1000). Non-Western immigrant women had a 1.3-fold increased risk of severe maternal morbidity (95% CI 1.2-1.5) when compared with Western women. Overall case fatality rate was 1 in 53. Substandard care was found in 39 of a subset of 63 women (62%) through clinical audit.Conclusions Severe maternal morbidity complicates at least 0.71% of all pregnancies in the Netherlands, immigrant women experiencing an increased risk. Since substandard care was found in the majority of assessed cases, reduction of severe maternal morbidity seems a mandatory challenge.Keywords Ethnicity, incidence, maternal mortality, nationwide, risk factors, severe maternal morbidity, substandard care.Please cite this paper as: Zwart J, Richters J, Ö ry F, de Vries J, Bloemenkamp K, van Roosmalen J. Severe maternal morbidity during pregnancy, delivery and puerperium in the Netherlands: a nationwide population-based study of 371 000 pregnancies. BJOG 2008;115:842-850.

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“…Many studies have shown that previous delivery by caesarean section is associated with abnormal placentation, haemorrhage and peripartum hysterectomy. [13][14][15] Among the population studied, 40.2% were multipara (3 and more) and 23.1% had history of previous caesarean section indicating that these variables are significant risk factors for massive obstetric haemorrhage. Other identifiable risk factors studied include anemia and preeclampsia.…”

Section: Resultsmentioning

confidence: 95%

Retrospective study of massive obstetric haemorrhage and its materno fetal outcomes in a tertiary care centre

Padmasekar

Jothy

2017

Int J Reprod Contracept Obstet Gynecol

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Background: Massive obstetric haemorrhage is defined as blood loss of >1500 ml, or a decrease in haemoglobin>4 gm/dl or acute transfusion requirement of >4 units of blood when need for further transfusion is foreseeable. The purpose of this study is to analyse the demographic, medical and obstetric risk factors for massive obstetric haemorrhage and it’s materno fetal outcomes.Methods: Criteria for patient selection was all patients who had an acute obstetric haemorrhage necessitating a transfusion of >4 units of blood at a stretch when there was a need for more. This is a retrospective study conducted for a period of one year January to December 2015. Data regarding all cases under study during this period was obtained from Medical Records Department with prior permission. This study was conducted in the Department of Obstetrics and Gynecology, Government Raja Mirasudhar Teaching Hospital, Thanjavur Medical College, Tamil Nadu. Maternal outcomes like mode of delivery, rate of hysterectomy, postpartum complications, maternal mortality and fetal outcomes like intra uterine death, still birth and preterm birth were analysed.Results: The rate of massive obstetric haemorrhage in our hospital during the study period was 5.7/1000 births. Massive obstetric haemorrhage contributed to 25% of all maternal deaths in 2015. Atonic PPH was the commonest cause. Multiparity and previous caesarean section were identified to be significant risk factors.Conclusions: We found an increased association of massive obstetric haemorrhage with multiparity, caesarean sections and pre-eclampsia. Atonic PPH was the commonest cause. Massive obstetric haemorrhage had contributed significantly to adverse maternal and perinatal outcomes.

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Investigation of an increase in postpartum haemorrhage in Canada

Cited by 265 publications

References 17 publications

Hospital Data Reporting on Postpartum Hemorrhage: Under-Estimates Recurrence and Over-Estimates the Contribution of Uterine Atony

Hospital Data Reporting on Postpartum Hemorrhage: Under-Estimates Recurrence and Over-Estimates the Contribution of Uterine Atony

Severe maternal morbidity during pregnancy, delivery and puerperium in the Netherlands: a nationwide population‐based study of 371 000 pregnancies

Retrospective study of massive obstetric haemorrhage and its materno fetal outcomes in a tertiary care centre

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