Exploring trends of severe postpartum haemorrhage: a hospital-based study

Abstract

Background Over the past two decades several high-income countries have reported increased rates of postpartum haemorrhage (PPH). Many of the studies are registry studies with limited access to detailed information. We aimed to explore trends of severe PPH in the largest labour ward in Norway during a 10-year period with a hospital based study. Our population constituted all women who gave birth after week 22 at Oslo University Hospital between 2008 and 2017. The main outcome measure was severe PPH, defined as registered blood loss greater than 1500 ml, or transfusion of blood products due to PPH. Methods We estimated the incidence of severe PPH and blood transfusions, and performed temporal trend analysis. We performed Poisson regression analysis to investigate associations between pregnancy characteristics and severe PPH, presented using crude incidence rate ratios (IRR) with 95% confidence intervals (CI)s. We also estimated annual percentage change of the linear trends. Results Among 96 313 deliveries during the 10-year study period, 2621 (2.7%) were diagnosed with severe PPH. The incidence rate doubled from 17.1/1000 to 2008 to 34.2/1000 in 2017. We also observed an increased rate of women receiving blood transfusion due to PPH, from 12.2/1000 to 2008 to 27.5/1000 in 2017. The rates of invasive procedures to manage severe PPH did not increase, and we did not observe a significant increase in the number of women defined with maternal near miss or massive transfusions. No women died due to PPH during the study period. Conclusion We found a significant increasing trend of severe PPH and related blood transfusions during the 10-year study period. We did not find an increase in massive PPH, or in invasive management, and we suspect that the rise can be at least partly explained by increased awareness and early intervention contributing to improved registration of severe PPH.

Targeting a higher plasma VWF level at time of delivery in pregnant individuals with von Willebrand disease: Outcomes at a single‐institution cohort study

“…reported a rate of 11.1% (six out of 54 deliveries in individuals with VWD in England between 1980 and 1996) when targeting VWF parameters of ≥50 IU/dL, which is similar to our rate of early PPH of 12.8% 11 . This presumed ‘lack’ of improvement may be accounted for by the fact that rates of severe PPH in the general population have been increasing over the past decades globally—even in high‐income countries with easy access to uterotonic medications 20,21 . From 2001 to 2012, the rates of PPH requiring blood transfusions increased from 1.6 to 3.8 per 1000 delivery hospitalization in the United States 20 .…”

“…From 2001 to 2012, the rates of PPH requiring blood transfusions increased from 1.6 to 3.8 per 1000 delivery hospitalization in the United States 20 . Similarly, a study in Norway found that the rate of severe PPH doubled from 17.1/1000 deliveries in 2008 to 34.2/1000 deliveries in 2017 21 . This may also explain why our study had a higher rate of early PPH when compared with earlier studies using a similar target of ≥100 IU/dL 22 .…”

“…20 Similarly, a study in Norway found that the rate of severe PPH doubled from 17.1/1000 deliveries in 2008 to 34.2/1000 deliveries in 2017. 21 This may also explain why our study had a higher rate of early PPH when compared with earlier studies using a similar target of ≥100 IU/dL. 22 It is worth mentioning that of the three pregnancies that achieved VWF:RCo levels ≥100 IU/dL in the third trimester (correctors), two of them developed early PPH that was due to retained placenta and 3 rd degree laceration.…”

“…11 This presumed 'lack' of improvement may be accounted for by the fact that rates of severe PPH in the general population have been increasing over the past decades globally-even in high-income countries with easy access to uterotonic medications. 20,21 From 2001 to 2012, the rates of PPH requiring blood transfusions increased from 1.6 to 3.8 per 1000 delivery hospitalization in the United States. 20 Similarly, a study in Norway found that the rate of severe PPH doubled from 17.1/1000 deliveries in 2008 to 34.2/1000 deliveries in 2017.…”

Predictive Modelling of Postpartum Haemorrhage Using Early Risk Factors: A Comparative Analysis of Statistical and Machine Learning Models

“…This revision was prompted by the routine underestimation of blood loss during delivery [2]. In global clinical practice, there is a lack of consensus on the definition of PPH [3]. This challenges regional and national comparisons of the prevention and management of PPH [3].…”