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Table 1 Demographics of women experiencing postpartum haemorrhage in Wales and uptake of the OBS Cymru intervention

From: Reduction in massive postpartum haemorrhage and red blood cell transfusion during a national quality improvement project, Obstetric Bleeding Strategy for Wales, OBS Cymru: an observational study

  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
  1. Legend a:One obstetric unit did not report any data for this intervention and has been excluded from the analysis and btwo obstetric units did not return Rotem data between July and December 2018. A more complete dataset was collected for PPH ≥1500 mL and so Rotem analyses and laboratory results are only reported for these cases