Abstract
This study aimed to explore whether recording of a prior adverse pregnancy outcome (postpartum hemorrhage) in a medical record increases the likelihood that recurrence of the same event is reported in hospital data. Using a sample of 588 pregnancies [2 consecutive pregnancies for 294 randomly selected women with at least one postpartum hemorrhage (PPH)], we compared ‘coded’ recurrence rates in hospital data with those obtained from medical record audit. ‘Coded’ recurrence in a second pregnancy was also compared for women with or without a documented history of prior PPH. We found a ‘coded’ recurrence rate of 18.5% and an ‘audited’ recurrence rate of 28.4%. The ‘coded’ rate of recurrence among women who had a documented history of PPH was 27.4% compared to 19.1% when the previous PPH was not noted in the second pregnancy medical record. Medical record reporting of uterine atony as the cause for postpartum hemorrhages in first and second births was 37.9 and 34.0% while ‘coded’ hospital data reporting attributed 79.8 and 73.9% respectively to atony. Our study results indicate that a history of postpartum hemorrhage may be a stronger risk factor for subsequent PPH than previously demonstrated. A recorded history of PPH was associated with an increased likelihood of reporting a subsequent PPH, and in such cases recurrence rates approximate true recurrence. The contribution of uterine atony as a cause of postpartum hemorrhage is over-estimated using hospital data.
Similar content being viewed by others
References
Callaghan, W. M., & Kuklina, E. V., et al. (2010). Trends in postpartum hemorrhage: United States, 1994–2006. American Journal of Obstetrics and Gynecology, 202(4), 353 e351–353 e356.
Joseph, K. S., Rouleau, J., et al. (2007). Investigation of an increase in postpartum haemorrhage in Canada. BJOG: An International Journal of Obstetrics & Gynaecology, 114(6), 751–759.
Ford, J. B., Roberts, C. L., et al. (2007). Increased postpartum hemorrhage rates in Australia. International Journal of Gynaecology and Obstetrics, 98, 237–243. doi:10.1016/j.ijgo.2007.03.011.
Roberts, C. L., & Ford, J. B., et al. (2009). Trends in adverse maternal outcomes during childbirth: A population based study of maternal morbidity. BMC Pregnancy Childbirth, 9(7). doi:10.1186/1471-2393-9-7.
Callaghan, W. M., & MacKay, A. P., et al. (2008). Identification of severe maternal morbidity during delivery hospitalizations, United States, 1991–2003. American Journal of Obstetrics and Gynecology, 199(2), 133.e131–133.e138.
Knight, M., Callaghan, W. M., et al. (2009). Trends in postpartum hemorrhage in high resource countries: A review and recommendations from the International Postpartum Hemorrhage Collaborative Group. BMC Pregnancy Childbirth, 9, 55.
Wilcox, A. J. (2007). The analysis of recurrence risk as an epidemiological tool. Paediatric and Perinatal Epidemiology, 21 Suppl 1, 4–7.
Bhattacharya, S., Prescott, G. J., et al. (2010). Recurrence risk of stillbirth in a second pregnancy. BJOG: An International Journal of Obstetrics & Gynaecology, 117(10), 1243–1247.
Adams, M., Elam-Evans, L., et al. (2000). Rates of and factors associated with recurrence of preterm delivery. Journal of the American Medical Association, 283(12), 1591–1596.
Ford, J. B., Roberts, C. L., et al. (2010). Recurrence of breech presentation in consecutive pregnancies? BJOG: An International Journal of Obstetrics & Gynaecology, 117, 83–836.
Hernandez-Diaz, S., & Toh, S., et al. (2009). Risk of pre-eclampsia in first and subsequent pregnancies: Prospective cohort study. BMJ, 338, b2255.
Ford, J. B., Roberts, C. L., et al. (2007). Postpartum haemorrhage occurrence and recurrence: A population-based study. Medical Journal of Australia, 187(7), 391–393.
Lain, S. J., & Hadfield, R. M., et al. (2011). Quality of data in perinatal population health databases: A systematic review. Medical Care, May 25, 2011. [Epub ahead of print].
Roberts, C. L., Bell, J. C., et al. (2008). The accuracy of reporting of hypertensive disorders of pregnancy in population health data. Hypertension in Pregnancy, 27(3), 285–297.
Breathnach, F., & Geary, M. (2009). Uterine atony: Definition, prevention, nonsurgical management, and uterine tamponade. Seminars in Perinatology, 33(2), 82–87.
National Centre for Classification in Health. (2004). The international statistics classification of diseases and related health problems, tenth revision, Australian modification. Sydney: National Centre for Classification in Health, University of Sydney.
National Centre for Classification in Health. (2006). Australian classification of health interventions. Sydney: University of Sydney.
National Centre for Classification in Health. (2006). Australian coding standards. Sydney: Commonwealth of Australia.
Lain, S. J., Roberts, C. L., et al. (2008). How accurate is the reporting of obstetric haemorrhage in hospital discharge data? A validation study. Australian and New Zealand Journal of Obstetrics and Gynaecology, 48(5), 481–484.
Taylor, L., Travis, S., et al. (2005). How useful are hospital morbidity data for monitoring conditions occurring in the perinatal period? Australian and New Zealand Journal of Obstetrics and Gynaecology, 45, 36–41.
Pym, M., & Taylor, L. (1993). Validation study of the NSW Midwives data collection 1990. NSW Public Health Bulletin, 1993(4), 1–6.
Geller, S. E., & Ahmed, S., et al. (2004). International classification of diseases-9th revision coding for preeclampsia: how accurate is it? American Journal of Obstetrics and Gynecology, 190(6), 1629–1633; discussion 1633–1624.
Roberts, C. L., Ford, J. B., et al. (2009). Population rates of haemorrhage and transfusions among obstetric patients (letter). Australian and New Zealand Journal of Obstetrics and Gynaecology, 49, 296–298.
National Centre for Classification in Health. (2006). Australian coding standards for ICD-10-AM and ACHI. Sydney: National Centre for Classification in Health.
Razvi, K., Chua, S., et al. (1996). A comparison between visual estimation and laboratory determination of blood loss during the third stage of labour. Australian and New Zealand Journal of Obstetrics and Gynaecology, 36(2), 152–154.
Dildy, G. A. I., & Paine, A. R., et al. (2004). Estimating blood loss: Can teaching significantly improve visual estimation? Obstetrics & Gynecology, 104(3), 601–606. doi:610.1097/1001.AOG.0000137873.0000107820.0000137834.
Roberts, C. L., Lain, S., et al. (2007). Quality of population health reporting by mode of delivery. Birth, 34(3), 274–275.
Roberts, C. L., Algert, C. S., et al. (2008). Reporting of routinely collected data by public and private hospitals (letter). Australian and New Zealand Journal of Obstetrics and Gynaecology, 48(5), 521–522.
Adams, M. M. (2001). Validity of birth certificate data for the outcome of the previous pregnancy, Georgia, 1980–1995. American Journal of Epidemiology, 154(10), 883–888.
Green, D. C., Moore, J. M., et al. (1998). Are we underestimating rates of vaginal birth after previous cesarean birth? The validity of delivery methods from birth certificates. American Journal of Epidemiology, 147(6), 581–586.
Chen, C., Roberts, C. L., et al. (2010). Assessing data quality by record linkage: Using longitudinal data to validation cross-sectional reporting of previous caesarean birth. Journal of Clinical Epidemiology, 63(6), 672–678.
Ananth, C. V. (2007). Epidemiologic approaches for studying recurrent pregnancy outcomes: Challenges and implications for research. Seminars in Perinatology, 31(3), 196–201.
Acknowledgments
This study was funded by an Australian National Health and Medical Research Council (NHMRC) Project Grant (512162). Jane Ford is supported by NHMRC grant 512162 and Christine Roberts is supported by a NHMRC Senior Research Fellowship. We thank the NSW Department of Health for access to the hospital and birth data and the NSW Centre for Health Record for linking the datasets required to select the study sample.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Ford, J.B., Algert, C.S., Kok, C. et al. Hospital Data Reporting on Postpartum Hemorrhage: Under-Estimates Recurrence and Over-Estimates the Contribution of Uterine Atony. Matern Child Health J 16, 1542–1548 (2012). https://doi.org/10.1007/s10995-011-0919-1
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10995-011-0919-1