Logo image
Back
Identifying the risk: a prospective cohort study examining postpartum haemorrhage in a regional Australian health service
Journal article   Open access   Peer reviewed

Identifying the risk: a prospective cohort study examining postpartum haemorrhage in a regional Australian health service

Lauren Kearney, Mary Kynn, Rachel Reed, Lisa Davenport, Jeanine Young and Keppel Schafer
BMC pregnancy and childbirth, Vol.18, 214
2018
DOI: https://doi.org/10.1186/s12884-018-1852-8
pdf
PDF - Published Version (Open Access)791.83 kBDownloadView
Published VersionPDF - Published Version (Open Access)CC BY V4.0,  Open Access
url
https://doi.org/10.1186/s12884-018-1852-8View
Published Version

Abstract

active management blood loss measures estimated blood loss expectant management gravimetric postpartum haemorrhage third stage labour management
Background: In industrialised countries the incidence of postpartum haemorrhage (PPH) is increasing, for which exact etiology is not well understood. Studies have relied upon retrospective data with estimated blood loss as the primary outcome, known to be underestimated by clinicians. This study aimed to explore variables associated with PPH in a cohort of women birthing vaginally in coastal Queensland, Australia, using the gravimetric method to measure blood loss. Methods: Women were prospectively recruited to participate using an opt-out consent process. Maternal demographics; pregnancy history; model of care; mode of birth; third stage management practices; antenatal, intrapartum and immediate postpartum complications; gravimetric and estimated blood loss; and haematological laboratory data, were collected via a pre-designed data collection instrument. Descriptive statistics were used for demographic, intrapartum and birthing practices. A General Linear Model was used for multivariate analysis to examine relationship between gravimetric blood loss and demographic, birthing practices and intrapartum variables. The primary outcome was a postpartum haemorrhage (blood loss > 500 ml). Results: 522 singleton births were included in the analysis. Maternal mean age was 29 years; 58% were multiparous. Most participants received active (291, 55.7%) or modified active management of third stage (191, 36. 6%). Of 451 births with valid gravimetric blood loss recorded, 35% (n = 159) recorded a loss of 500 ml or more and 111 (70%) of these were recorded as PPH. Gravimetric blood loss was strongly correlated with estimated blood loss (r = 0.88; p < 0.001). On average, the estimated blood loss was lower than the gravimetric blood loss, about 78% of the measured value. High neonatal weight, perineal injury, complications during labour, separation of mother and baby, and observation of a gush of blood were associated with PPH. Nulliparity, labour induction and augmentation, syntocinon use were not associated with PPH. Conclusions: In contrast to previous study findings, nulliparity, labour induction and augmentation were not associated with PPH. Estimation of blood loss was relatively accurate in comparison to gravimetric assessment; raising questions about routine gravimetric assessment of blood loss following uncomplicated births. Further research is required to investigate type and speed of blood loss associated with PPH.

Details

Metrics

39 File views/ downloads
556 Record Views
10 Times Cited - Web of Science

InCites Highlights

These are selected metrics from InCites Benchmarking & Analytics tool, related to this output

Collaboration types
Domestic collaboration
Web Of Science research areas
Obstetrics & Gynecology

UN Sustainable Development Goals (SDGs)

This output has contributed to the advancement of the following goals:

#3 Good Health and Well-Being
#5 Gender Equality

Source: InCites

Logo image