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.
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.
- Content Type Journal Article
- Pages 1-7
- DOI 10.1007/s10995-011-0919-1
- Authors
- Jane B. Ford, Clinical and Population Perinatal Health Research, Kolling Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
- Charles S. Algert, Clinical and Population Perinatal Health Research, Kolling Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
- Cindy Kok, Clinical and Population Perinatal Health Research, Kolling Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
- Melinda A. Choy, Clinical and Population Perinatal Health Research, Kolling Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
- Christine L. Roberts, Clinical and Population Perinatal Health Research, Kolling Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
- Journal Maternal and Child Health Journal
- Online ISSN 1573-6628
- Print ISSN 1092-7875