[Maternal postpartum anaemia--tendencies and variability, considering different hospital categories--research on the basis of Perinatology in Baden-Württemberg].
BACKGROUND
Postpartum anaemia continues to be the most common puerperal complication in Germany. Interest, however, increases in maternal quality of life after delivery and with regard to scarce resources in the costs associated with anaemia.


METHODS
With this background, perinatal survey data of Baden-Wurttemberg 1998 - 2003 (566,920 pregnancies) were studied regarding development and variability of anaemia in pregnancy and puerperium.


RESULTS
The anaemia rate post-partum increased from 1998 to 2003 (1998 12.2 %, 2003 15.6 %). This is a significant trend. The category of small hospital departments, however, had lower rates in 2003 than in 1998. Significant differences exist between the rates of the hospital categories. High-volume departments show the highest rate (e. g., 2003: hospital departments > 1000 deliveries per year 23.2 %, consultant departments < 500 deliveries per year 9.4 %). The differences existed throughout the observed period and remained significant when all pregnancies with risk factors associated with higher blood loss were not taken into account and methods of delivery were considered separately. In 2003, anaemia during pregnancy, up to then documented for less then 2 % of the pregnancies, showed a much higher rate (e. g., high-volume departments: 6-fold higher than in 2002).


CONCLUSIONS
Many factors may contribute to these differences, including aspects of obstetrical management, volume-outcome associations, and documentation.


CONCLUSIONS
Reducing interhospital variability includes the option of reducing anaemia rates post-partum. Analysis and reflection of these results within the departments may suggest strategic changes concerning prevention, therapy, obstetric management, and workload as well as documentation habits.
Simoes
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E
Kompetenz-Centrum Qualitätssicherung/Qualitätsmanagement beim Medizinischen Dienst der Krankenversicherung Baden-Württemberg, Lahr. e.simoes@mdkbw.de
Kunz
S
S
Bosing-Schwenkglenks
M
M
Schmahl
F W
FW
D000740:Anemia / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D015897:Comorbidity; D005260:Female; D005858:Germany / Q000453:epidemiology; D006760:Hospitalization / Q000706:statistics & numerical data* / Q000639:trends; D006801:Humans; D015994:Incidence; D018743:Perinatal Care / Q000706:statistics & numerical data* / Q000639:trends; D011247:Pregnancy; D015995:Prevalence; D011644:Puerperal Disorders / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors