Primary Post-Partum Haemorrhage; the Pilgrim Hospital’s Experience, Boston, Lincolnshire, United Kingdom

Abstract

Aim: This study was to investigate the incidence of primary post-partum haemorrhage (PPH), during the biennial period of 2007 to 2008; its management and outcomes and to learn from any peculiar challenges that the unit had faced in the management of these women in relation to PPH. The study was aimed to explore any significant risk factors, adverse outcomes and associated risks and compared these with standards, guidelines and other published acceptable practices. It was also aimed to critically appraise our methods of estimation of blood loss (EBL, blood loss) in the unit. Methods: We reviewed the Pilgrim Hospital Monthly Maternity Statistical Run from 2005 to 2008 for information on trends. We conducted a preliminary review of the Birth Register of 2007-8 with elimination criteria from the definition of primary postpartum haemorrhage (PPH), to identify the target population to be included in the study. Once the target population was identified, the investigators chose a study population of 100 of these women and had used a systematic approach to make sure that the study population clearly reflected with good precision, the target population. This was done as follows: Each of the 4 investigators had a group of 25 women to study and each group comprised of 8 women who had normal birth; 8 women who had vaginal operative deliveries; 8 women who had caesarean section and one additional woman with a mode of delivery randomly picked by each of the investigators but with this randomly picked mode of delivery different from that picked by the 3 other investigators. A careful review of 100 case notes was conducted in stages by investigators to ascertain the management these women and the outcomes of such management. The investigators met formally about three times and informally many times to articulate, review, updated and implement the strategies for the study. Results: From the preliminary screening, the following specific data was collated: i. The number of deliveries for 2007 was 1963 and that of 2008 was 2169. ii. The total number of deliveries for the same period was 4132. The number of women delivered whose blood loss met the criteria for PPH were 390 or giving rise to an incidence of 9.44% (cf 2-11%) for the 2 years (20072008) or average incidence of 4.72% (cf 2-11%) for each of the 2 years. iii. These 390 cases as stated earlier constituted the target population. The number of women whose blood loss did not meet the criteria were 621 (15.03%) for the same time frame. 100 cases (25.64%) of target population had been chosen as our study population as earlier stated. iv. In 44 women (1.06%), the blood loss was recorded as a range of values and therefore the incidence cannot be calculated based on the two figures in the range and thus