Volume 188 - Issue 12
Postpartum haemorrhage occurrence and recurrence: a population-based study
Authors: Jane B Ford, Christine L Roberts, Jane C Bell, Charles S Algert and Jonathan M Morris
Med J Aust 2008; 188 (12): 731. || doi: 10.5694/j.1326-5377.2008.tb01859.x
Published online: 16 June 2008
Published online: 16 June 2008
In reply: Safety and appropriateness are important principles underlying the provision of health care. Maternity care in Australia requires that women are offered care in an environment that is appropriate to their level of risk. Such a risk-management approach requires accurate data to inform the process, including accurate identification of women who may access local services as well as those who may benefit from higher levels of care. The aim of our study was to present risk estimates of recurrent postpartum haemorrhage (PPH) to better inform decision making by both clinicians and women about subsequent pregnancies.
While we are aware of the struggles faced by rural maternity units, we estimated that only 0.2% of women giving birth in New South Wales would be affected by our suggestion that women with a history of PPH consider delivering at a hospital with onsite cross-match facilities. The definition of PPH that we used is consistent with that of the International classification of diseases1 and the NSW Department of Health’s PPH policy;2 this policy resulted from a review of hospital PPH policies sparked by a coronial inquest into a maternal death.3
In contrast to Tracy et al’s study, which only considered low-risk women and had no maternal morbidity outcomes,4 our study calculated risk among all women. Women with a PPH are at increased risk of transfusion, intensive care unit admission, unplanned procedure in the operating theatre, hysterectomy and major maternal morbidity.3 Where we have information about an increased risk of a potentially life-threatening event, surely we should communicate and act on this knowledge to achieve the best possible outcome for women and babies.
In Canada, which has similar geographical challenges to those in Australia, it is recommended that where risk factors for PPH are identified, additional precautions such as intravenous access, coagulation studies, and availability of anaesthesia should also be considered.5 The key to successful regionalised maternity care is ensuring that women give birth in risk-appropriate settings.
References
- National Centre for Classification in Health. The international statistical classification of diseases and related health problems, 10th revision, Australian modification. Sydney: NCCH, University of Sydney, 2004.
- NSW Department of Health. Postpartum haemorrhage (PPH) — framework for prevention, early recognition and management. Sydney: The Department, 2005. http://www5.health.nsw.gov.au/policies/PD/2005/PD2005_264.html (accessed Feb 2008).
- Cameron CA, Roberts CL, Olive EC, et al. Trends in postpartum haemorrhage. Aust N Z J Public Health 2006; 30: 151-156. CBBGAICE
- Tracy SK, Sullivan E, Dahlen H, et al. Does size matter? A population-based study of birth in lower volume maternity hospitals for low risk women. BJOG 2006; 113: 86-96. i1091841
- Schuurmans N, MacKinnon C, Lane C, Etches D. Prevention and management of postpartum haemorrhage. SOGC Clinical Practice Guidelines. Vol. 88. Ottawa: Society of Obstetricians and Gynaecologists of Canada, 2000. http://www.sogc.org/guidelines/public/88E-CPG-April2000.pdf (accessed Feb 2008).