Table 1 Demographics of women experiencing postpartum haemorrhage in Wales and uptake of the OBS Cymru intervention
| Â | Jan-Jun 2017 | Jul-Dec 2017 | Jan-Jun 2018 | Jul-Dec 2018 |
|---|---|---|---|---|
Total number of maternities in Wales | 15,204 | 15,986 | 14,754 | 15,150 |
Episodes with ≥ 1000 mL blood loss or clinical concern of abnormal bleeding N (/1000 maternities) | 1448 (95.2) | 1519 (95.1) | 1499 (101.6) | 1558 (102.8) |
Episodes with ≥ 1500 mL blood loss N (/1000 maternities) | 547 (36.0) | 588 (36.8) | 530 (35.9) | 544 (35.9) |
Mode of delivery | ||||
 Unassisted vaginal: n (%) | 211 (38.6) | 228 (38.8) | 203 (38.3) | 184 (33.8) |
 Instrumental vaginal: n (%) | 115 (21.0) | 116 (19.7) | 123 (23.2) | 147 (27.0) |
 Non-emergency caesarean section: n (%) | 181 (33.1) | 194 (33.0) | 170 (32.1) | 161 (29.6) |
 Emergency caesarean section: n (%) | 40 (7.3) | 50 (8.5) | 34 (6.4) | 51 (9.4) |
 Not recorded: n (%) | 0 (0) | 0 (0) | 0 (0) | 1 (0.2) |
Cause of bleeding for episodes with ≥ 1500 mL blood loss N (%) (NB many bleeds had multiple causes) | ||||
 Uterine atony | 323 (59.0) | 352 (59.9) | 276 (52.1) | 315 (57.9) |
 Surgery related | 142 (26.0) | 142 (24.1) | 135 (25.5) | 161 (29.6) |
 Genital tract trauma | 175 (32.0) | 185 (31.5) | 178 (33.6) | 189 (34.7) |
 Extragenital bleeding only | 6 (1.1) | 1 (0.2) | 12 (2.3) | 5 (0.9) |
 Uterine rupture | 4 (0.7) | 4 (0.7) | 1 (0.2) | 0 (0.0) |
 Placenta praevia | 16 (2.9) | 8 (1.4) | 15 (2.8) | 10 (1.8) |
 Placenta accrete | 5 (0.9) | 7 (1.2) | 5 (0.9) | 5 (0.9) |
 Amniotic fluid embolus | 0 (0.0) | 1 (0.2) | 0 (0.0) | 0 (0.0) |
 Uterine inversion | 1 (0.2) | 1 (0.2) | 0 (0.0) | 1 (0.2) |
 Placental abruption | 17 (3.1) | 14 (2.4) | 17 (3.2) | 23 (4.2) |
 Retained products | 63 (11.5) | 46 (7.8) | 57 (10.8) | 45 (8.3) |
 No cause reported | 1 (0.2) | 0 (0.0) | 1 (0.2) | 0 (0.0) |
First blood test after recognition of haemorrhage for PPH ≥ 1500 mL | ||||
 Haemoglobin g/L: Med (IQR), range | 104 (93–114) 62–156 | 104 (94–115) 57–164 | 103 (93–115) 60–146 | 102 (92–113) 52–144 |
 Clauss fibrinogen g/L: Med (IQR) | 4.2 (3.6–5) 0.3–7.9 | 4.2 (3.6–4.9) 0.6–7.4 | 4.3 (3.7–4.9) 0.3–8.3 | 4.3 (3.7–4.9) 0.4–9.8 |
Uptake of OBS Cymru intervention | ||||
 Risk assessment completed. All Wales: n (% of all episodes ≥1000 mL)a | 23 (1.6) | 399 (26.2) | 931 (62.1) | 1003 (64.4) |
 Percent completion in individual units: Med (IQR) range a | 0.8 (0–1.7) 0–3.3 | 25 (22–40) 16–59 | 82 (74–90) 36–96 | 88 (68–97) 37–99 |
 Paperwork completed. All Wales: n (% of all episodes ≥1000 mL) a | 28/1166 (2.4) | 503/1274 (39.5) | 724/1210 (59.8) | 802/1262 (63.5) |
 Percent completion in individual units: Med (IQR), range a | 1.6 (0–3.1), 0–6.1 | 45.4 (24.0–53.2), 10.2–66.4 | 53.3 (40.6–79.7) 18.1–97.2 | 62.4 (45.9–85.1) 10.9–97.6 |
 Blood loss quantitatively measured All Wales: n (% of all episodes ≥1000 mL) | 1204 (83) | 1409 (93) | 1404 (93.7) | 1530 (98.2) |
 Percent blood loss measurement in individual units: Med (IQR) range | 76.7 (81.9–90.2) 38–98 | 93.6 (88.6–97.6) 86–100 | 93.7 (88.8–98.5) 85–100 | 99.1 (98.3–99.6) 95–100 |
 Rotem analysis performed: n (% of episodes with bleeds ≥1500 mL) | 206 (37.7) | 346 (58.8) | 380 (71.7) | 371 (68.2) b |
 Percent Rotem analyses performed in individual units: Med (IQR) range | 24.9 (16.2–44.9) 10–88 | 57.2(39.0–74.4) 9–88 | 59.2 (67.5–83.0) 39–100 | 85.2 (75.3–90.6) b 16–96 |
 Rotem analysis requiring intervention and acted on according to algorithm: n (% of episodes with bleeds > 1500 mL) | 3/16 (19) | 18/35 (51) | 19/29 (65) | 25/37 (68) b |