National Women's Annual Clinical Report 2010

Table 61: Postpartum haemorrhage rate (1995-2010)
1995 1996 1997 1998 1999 2000 2004 2005* 2006* 2007* 2008 2009 2010
Total Births 9125 9157 8055 7531 7501 7827 7491 7194 7212 7695 7589 7735 7709
Primary PPH
(>500mls)
1655 1633 1882 1818 1921 2088 2056 2139 2302 2507 2736 2850 2753
Incidence % 18.1 17.8 23.4 24.1 25.6 26.7 27.4 29.7 31.9 32.6 36.1 36.9 35.7
Primary PPH
(>1000mls)
267 344 303 318 381 423 262 350 351 410 634 651 695
Incidence % 2.9 3.8 3.8 4.2 5.1 5.4 3.5 4.9 4.9 5.3 8.4 8.4 9.0
Data corrected in 2005- 2007. See methodology above.
Table 62: Postpartum blood loss by mode of birth
Spontaneous
vaginal birth
n=4276
Operative
vaginal birth
n=942
CS
emergency
n=1265
CS elective
n=1226
Total
N=7709
n % n % n % n % n %
PPH >500mls 700 16.4 266 28.2 991 78.3 796 64.9 2753 35.7
PPH >1000mls 219 5.1 84 8.9 254 20.1 138 11.3 695 9.0
PPH >1500mls 109 2.6 32 3.4 86 6.8 31 2.5 258 3.4
Post partum transfusion 72 1.7 34 3.6 60 4.7 24 2.0 190 2.5
Table 63: Postpartum blood loss by onset of birth
Spontaneous
labour
n=4007
Induced
labour
n=2214
CS emergency
before onset of
labour
n=266
CS elective
n=1222
Total
N=7709
n % n % n % n % n %
PPH >500mls 1001 25.0 765 34.6 194 72.9 793 64.9 2753 35.7
PPH >1000mls 283 7.1 224 10.1 50 18.8 138 11.3 695 9.0
PPH >1500mls 121 3.0 87 3.9 19 7.1 31 2.5 258 3.4
Post partum transfusion 81 2.0 66 3.0 19 7.1 24 2.0 190 2.5
Of all women giving birth, the overall primary PPH rate (> 500mls) was 36%. It varied by
mode of birth, from 16% for spontaneous vaginal birth to 78% for emergency caesarean. It
also varied by onset of birth, from 25% in spontaneous onset to 35% in induced labour. The
rate of blood loss > 1500mls for women having a vaginal birth remained stable in 2010 at
2.7%, and for women having a caesarean has slightly decreased over the last few years to
4.7% in 2010. Only 2.5% of all mothers giving birth received a blood transfusion post-partum,
with little variation by onset of birth.
The introduction of new guidelines for PPH late in 2009 were expected to result in an
increased use of syntometrine for prevention of PPH in women at risk, together with a more
consistent approach to calling for help. Although we did not analyze PPH rates in the subset
of women at risk, we did see an overall reduction in the blood transfusion rate from 3.3% in
2009 to 2.6% in 2010 which may be in part due to the new guidelines. The introduction of a
new checklist for PPH in 2010, combined with a hospital-wide promotion of reassessing the
need for a second unit of blood, may result in a further reduction in overall transfusion rate
next year.
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