Re: [ozmidwifery] PPH levels soar

[Janet Fraser]

Four words, Kimmy, cord traction and induction! When will we learn to leave stuff alone? We had a massive "stastical blip" in emergency hysterectomies in Vic recently and there was much handwringing and exclamations of "Good lord how did that happen?!" It's not going away on it's own, people! : ( J ----- Original Message ----- From: Sue Cookson To: ozmidwifery@acegraphics.com.au Sent: Sunday, June 11, 2006 6:49 PM Subject: [ozmidwifery] PPH levels soar Hi, This article appeared in last week's Sydney Morning Herald. I think it's amazing and it appears that some of the information is incorrect in that the article states that NSW Health implemented active thrid stage and early cord clamping in 2002. Surely syntometrine and syntocinon have been used for many more years than just the last four, in which case this study is a real eye-opener if you believe we are stopping women from bleeding by using drugs in third stage. What do you think? Sue Transfusions soar for women giving birth Julie Robotham Medical Editor June 3, 2006 RECORD numbers of NSW women need transfusions to treat massive blood loss after giving birth, in an epidemic that doctors say is threatening new mothers' health and fertility and sometimes their lives. The number of women diagnosed with post-partum hemorrhage has rocketed by nearly 30 per cent, and almost one in nine births was affected in 2002, compared to one in 12 in 1994, University of Sydney research has shown. Of those, the proportion whose condition was severe enough to warrant a blood transfusion increased sixfold, from 2 per cent to 12 per cent. "It's extremely important," said Ken Clark, the president of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Bleeding was "still a very real cause of the death of women but also a great deal of [ill health] that has a tremendous impact on women and their families". In the worst cases mothers had to undergo emergency hysterectomies to save their lives, but even less dramatic surgery to clamp blood vessels or anaemia could be debilitating. "To have that on top of all the other stresses and strains of motherhood it's the last thing people need," Dr Clark said. The NSW findings are the first large-scale confirmation of the impression among individual doctors and hospitals across Australia that major bleeding is increasing. Carolyn Cameron, who led the statewide analysis, said neither the well-documented rise in caesarean section births nor the growing number of older mothers could explain the increase in hemorrhages. It was possible more borderline cases were being identified, but this alone was unlikely to account for the increase. "We have to search for something else. It's a mystery," said Ms Cameron, a research officer at the Centre for Perinatal Health Services Research. The group would now look at how many previous pregnancies women had and the length of their labours to see whether these offered clues to the reasons for hemorrhage - diagnosed when more than 500 millilitres of blood is lost after a vaginal birth, or more than 750 millilitres after a caesarean. Blood loss - usually from the site where the placenta detaches - is currently the single largest cause of pregnancy-related death in Australia Between 1997 and 1999 - the most recent period for which figures are available - eight women died as a consequence, including two who refused transfusions for religious reasons. Ms Cameron's research, published in the Australian and New Zealand Journal of Public Health, was based on the medical records of more than 52,000 women who had a birth-related hemorrhage in NSW between 1994 and 2002. It is not yet clear whether the pattern has continued since 2002, when NSW Health recommended the use of drugs to expel the placenta and early clamping of the umbilical cord to limit bleeding. David Ellwood, professor of obstetrics and gynaecology at the Australian National University Medical School in Canberra, said: "All of the major hospitals around the country have been noticing an increase." Women who gave birth vaginally after a previous caesarean, or those carrying twins, might be at increased risk, he said. Rising birthweights might also contribute to the trend. Increasing transfusion numbers indicated that the severest bleeding was also rising, Professor Ellwood said - because doctors were reluctant to transfuse women with less serious hemorrhages. A group of maternity hospitals was researching women's recovery from birth hemorrhages to see whether they affected breastfeeding or triggered post-natal depression, he said. http://www.smh.com.au/news/national/transfusions-soar-for-women-giving-birth/2006/06/02/1148956546560.html#