Can hospital discharge data be used for monitoring indicators associated with postpartum hemorrhages? The HERA multicenter observational study.

OBJECTIVES: The principal objective of this study was to assess the reliability of measuring the incidence of postpartum hemorrhages (PPH) from the national hospital discharge summary database (PMSI). The secondary objectives were to assess this reliability according to the maternity unit level and status and to assess the measurement of second-line procedures for PPH.

MATERIALS AND METHODS: This study compared PPH incidence rates from February through July 2011 in 131 maternity units, as measured in the PMSI and the prospective HERA study cohort, considered as the reference standard.

RESULTS: Compared with the cohort, PPH incidence was over-reported in the PMSI among vaginal deliveries (4.0% vs. 3.5; P<0.0001), but not cesareans (3.2 vs. 2.9%; P=0.1). For the second-line curative procedures, PMSI data underestimated the incidence of vessel embolization and transfusion (P<0.0001) among vaginal deliveries and of hypogastric ligation (P=0.002), other vessel ligation (P=0.005), and transfusion (P<0.0001) among cesareans.

CONCLUSION: Despite some coding inaccuracy in the PMSI, routinely collected data can provide acceptable estimates for maternity units and perinatal networks to use to improve quality of care through the monitoring of quality indicators. Improvements are nonetheless needed for international comparisons and other epidemiologic purposes.