Sorry, forgot to give the link to the data for England, for what they are worth.
http://www.hesonline.nhs.uk/Ease/servlet/ContentServer?siteID=1937&categoryID=1047

Alison


-----Original Message-----
From: Macfarlane, Alison 
Sent: 05 November 2009 09:03
To: 'A forum for discussion on midwifery and reproductive health research.'
Subject: RE: National PPH rates



In the EUPHRATES study mentioned below, we tried to get units to tell us how many PPHs they had had in the previous calendar year, but we were unsuccessful. We also asked people about their definition of PPH and severe PPH and there were considerable differences. We didn't have room for that in the main paper and were going to write it in another. The problem is that the survey was in 2003 so the data are now out of date, but it sounds like it might be still worth getting it together.

Given the lack of consensus, there are problems in getting data from routine systems. In England, PPH is included among the complications recorded in Maternity HES and the reported rate is 10.1 per cent for the financial year 2008-09. Before quoting this, read the stuff on data quality, though. Before we did EUPHRATES, I looked at data by unit and the range was something like 3 per cent to 30 per cent, suggesting that wildly different definitions and inclusion criteria were being used.

In Scotland, special audits of severe maternal morbidity were set up but I can't find the link now as the organisation which did them got merged into NHS Quality Improvement Scotland. I am copying this to Jim Chalmers at ISD Scotland, so he can tell us what happened if no one on this list knows.



Alison Macfarlane
Department of Midwifery and Child Health
City University London
20 Bartholomew Close
London EC1A 7QN
Phone (0) (44) 207 040 5832
Fax   (0) (44) 207 040 5717
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-----Original Message-----
From: Briley, Annette [mailto:[log in to unmask]] 
Sent: 04 November 2009 19:41
To: [log in to unmask]
Subject: Re: National PPH rates

Hi Mandie
We have been collected data about all PPHs over a year in a London teaching hospital and will soon collect data for the same year from a DGH. Finding reliable stats is tricky as reporting varies hugely, with some areas reporting severe PPH as the need for a 4 or 5 unit transfusion, which probably gives more indication of practice than severity of PPH.

The LEMMoN study in the Netherland and the Euphrates study across Europe reported variance in measurement and treatment between units let alone regions and countries. 

There are some papers out of Australia showing a rise in PPH regardless of mode of delivery (Ford et al and Crowther et al) and an increase from 5% to 12% with normal deliveries in one city- although I can't remember which paper this is right now- will check and get back to you

If you find something more concrete do let me know!

Annette
Annette Briley
Consultant Midwife/Clinical Trial Manager
Maternal and Fetal Research Unit
10th Floor North Wing
St Thomas' Hospital
LONDON SE1 7EH
tel: 020 7188 3641
fax: 020 7620 1227
mob: 07710 348443

-----Original Message-----
From: A forum for discussion on midwifery and reproductive health research. [mailto:[log in to unmask]] On Behalf Of Mandie Scamell
Sent: 04 November 2009 12:53
To: [log in to unmask]
Subject: National PPH rates

Hi,
Hoping someone might be able to help me!  
Have come across interesting ethnographic data RE midwifery perception of 
PPH rates and am trying to test the perception against recorded national 
rates. 
Not with standing difficulties with definition and EBL etc. etc I am looking for 
rough ball park figures for the last 20 yrs.  While mortality rates from PPH are 
easily available, I am having trouble locating stats on the trends in over all 
incident rates. 
Any suggestions where a stats illiterate researcher should look? 
Thanks

Mandie

PS my data suggests midwives think the rate is increasing.  Surprising I think 
given the moving gate posts where a more symptomatic approach is applied in 
the defining process and where an appreciation that physiological third stage 
management is likely to be associated with an increase in initial loss (which, 
incidentally, is considered to be normal)

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