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Postpartum hemorrhage rate – definition vs. reality
Abstract Number: T 25
Abstract Type: Original Research
Background: Postpartum hemorrhage (PPH) rates have been increasing, in 1994 the average rate was 2.3% and in 2006 the rate was 2.9%.(1) Most studies that evaluate PPH rates are from national birth registries or billing data, which are often criticized as being inaccurate often underreporting incidences of events.(2, 3) ACOG defines postpartum hemorrhage as estimated blood loss (EBL) > 1000ml for cesarean section (CS), and >500ml for vaginal delivery(VD), or hematocrit(Hct) change >10% in either case.(4) We sought to identify with greater accuracy our institution’s PPH according to ACOGs criteria and compare it to the literature.
Methods: After IRB approval, a retrospective chart review was performed for calendar year 2008. Inclusion criteria was primigravid women aged >18 years admitted with gestational age >36 weeks . PPH was screened by Hct change greater than 10% and 20% from the time of admissions until 24 hours postpartum. EBL greater than 1000ml for CS or 500 ml for VD were noted.
Results: 500 patients were analyzed for this study. The criteria of change in hematocrit >10%, produced 42% of patients classified as PPH. Using a stricter definition of PPH of a hematocrit change >20%, the PPH rate was 21%. Only 6.7% of women with PPH by Hct change >10% had EBLs recorded consistent with PPH.
Conclusions: PPH is often quoted (1) as 2.9% while our study found 42%, a significantly higher rate. The EBL as a screening tool for PPH was exceedingly poor. Physician interpretation of the actual medical record resulted in a better understanding of PPH than by ICD-9 coding and provided a more accurate analysis of the data.(2,3) The patients in this study were primigravid and therefore were at a lower risk of PPH. Based on ACOGs definition (>10% Hct change) our incidence of PPH was staggeringly high, which the anesthesiologist and OB should be aware of. Even using a stricter PPH definition of >20% Hct change, the incidence of 21% would be of alarm to all clinicians. Further, improved screening tools should be developed to identify PPH e.g. use of postoperative uterotonics, to ensure patient safety, and healthcare providers should maintain high vigilance to the issue of PPH.
1. Am J Obstet Gynecol 2010; 202:353 e1-6.
2. Pediatrics 2011; 128:323-30.
3. Perspect Health Inf Manag 2011; 8:1b.
4. ACOG Practice Bulletin: Number 76, October 2006: Postpartum hemorrhage.