Maternal and Child Health Journal

, Volume 9, Issue 3, pp 297–306

Variations in the Incidence of Postpartum Hemorrhage Across Hospitals in California

  • Michael C. Lu
  • Moshe Fridman
  • Lisa M. Korst
  • Kimberly D. Gregory
  • Carolina Reyes
  • Calvin J. Hobel
  • Gilberto F. Chavez
Article
  • 294 Downloads

Objective: Because postpartum hemorrhage may result from factors related to obstetrical practice patterns, we examined the variability of postpartum hemorrhage and related risk factors (obstetrical trauma, chorioamnionitis, and protracted labor) across hospital types and hospitals in California. Methods: Linked birth certificate and hospital discharge data from 507,410 births in California in 1997 were analyzed. Cases were identified using International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) codes. Comparisons were made across hospital types and individual hospitals. Risk adjustments were made using 1) sample restriction to a subset of 324,671 low-risk women, and 2) Bayesian hierarchical logistic regression model to simultaneously quantify the effects of patient-level and hospital-level risk factors. Results: Postpartum hemorrhage complicated 2.4% of live births. The incidence ranged from 1.6% for corporate hospitals to 4.9% for university hospitals in the full sample, and from 1.4% for corporate hospitals to 3.9% for university hospitals in the low-risk sample. Low-risk women who delivered at government, HMO and university hospitals had two- to threefold increased odds (odds ratios 1.98 to 2.71; 95% confidence sets ranged from 1.52 to 4.62) of having postpartum hemorrhage compared to women who delivered at corporate hospitals, irrespective of patient-level characteristics. They also had significantly higher rates of obstetrical trauma and chorioamnionitis. Greater variations were observed across individual hospitals. Conclusion: The incidence of postpartum hemorrhage and related risk factors varied substantially across hospital types and hospitals in California. Further studies using primary data sources are needed to determine whether these variations are related to the processesof care.

KEY WORDS:

postpartum hemorrhage obstetrical trauma chorioamnionitis protracted labor variations quality 

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Copyright information

© Springer Science+Business Media, Inc. 2005

Authors and Affiliations

  • Michael C. Lu
    • 1
    • 3
    • 4
    • 10
  • Moshe Fridman
    • 7
  • Lisa M. Korst
    • 8
  • Kimberly D. Gregory
    • 3
    • 5
    • 6
  • Carolina Reyes
    • 5
  • Calvin J. Hobel
    • 1
    • 2
    • 5
    • 6
  • Gilberto F. Chavez
    • 9
  1. 1.Departments of Obstetrics and GynecologyDavid Geffen School of Medicine, UCLALos AngelesUSA
  2. 2.Departments of PediatricsDavid Geffen School of Medicine, UCLALos AngelesUSA
  3. 3.Department of Community Health SciencesUCLA School of Public HealthLos AngelesUSA
  4. 4.Center for Healthier Children, Families and CommunitiesUCLA School of Public HealthLos AngelesUSA
  5. 5.Department of Obstetrics and Gynecology, Divisions of Women's Health Services Research and PolicyCedars-Sinai Medical Center and Burns Allen Research InstituteLos AngelesUSA
  6. 6.Divisions of Maternal Fetal MedicineCedars-Sinai Medical Center and Burns Allen Research InstituteLos AngelesUSA
  7. 7.AMF Consulting, Inc.Los AngelesUSA
  8. 8.Saban Research Institute of Children's Hospital Los AngelesDepartments of Obstetrics and Gynecology and Pediatrics, Division of Research on Children, Youth and FamiliesLos AngelesUSA
  9. 9.California Department of Health ServicesLos AngelesUSA
  10. 10.Department of Obstetrics & GynecologyDavid Geffen School of Medicine at UCLALos AngelesUSA

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