Reporting errors, incidence and risk factors for postpartum haemorrhage and progression to severe PPH: a prospective observational study
Article first published online: 12 FEB 2014
© 2014 The Authors. BJOG An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd on behalf of Royal College of Obstetricians and Gynaecologists.
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
BJOG: An International Journal of Obstetrics & Gynaecology
Volume 121, Issue 7, pages 876–888, June 2014
How to Cite
Reporting errors, incidence and risk factors for postpartum haemorrhage (PPH) and progression to severe PPH: a prospective observational study. BJOG 2014;121:876–888., , , , , , , , .
- Issue published online: 20 MAY 2014
- Article first published online: 12 FEB 2014
- Manuscript Accepted: 24 SEP 2013
- Guy's and St Thomas' Charity. Grant Number: 251983
- Blood loss;
- observational study;
- risk factors;
- severe adverse maternal morbidity
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.