Incidence of immediate postpartum hemorrhages in French maternity units: a prospective observational study (HERA study)

Abstract

BackgroundMost estimates of postpartum hemorrhage (PPH) are calculated from studies that use administrative or medical birth databases, and only a few from prospective observational studies.Our principal objective was to estimate the incidence of PPH according to their severity (mild or severe) in vaginal deliveries (>500 mL, ≥1000 mL) and cesareans (>1000 mL and ≥1500 mL). The secondary objectives were to describe the incidence of PPH according to maternity unit characteristics, causes, and types of PPH management.MethodsThis prospective observational study took place in French maternity wards. Women who gave birth at a term ≥ 22 weeks were eligible for the study. 182 maternity units participated in a study with prospective data collection from 1 February, 2011, to 31 July, 2011. The main outcome measure was PPH incidence.ResultsPPH incidence after vaginal delivery was 3.36 % [95 % CI: 3.25–3.47 %] and after cesareans 2.83 % [95 % CI: 2.63–3.04 %]. The incidence of severe PPH after vaginal delivery was 1.11 % [95 % CI: 1.05–1.18 %] and after cesareans 1.00 % [95 % CI: 0.88–1.13 %]. This incidence rate varied according to maternity unit characteristics. The principal cause of PPH for both modes of delivery was uterine atony (57.7 % for vaginal births and 66.3 % for cesareans). Vascular embolization was more frequent among women with cesareans (10.0 vs. 2.9 %), who also required transfusions more often (44.4 vs 12.7 %).ConclusionsThe incidence of PPH was lower than the rate expected from the literature. Effective treatment of uterine atony and optimizing the identification of blood loss remain important priorities.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-016-1008-7) contains supplementary material, which is available to authorized users.

“Just in case”. Use of large-bore peripheral intravenous catheters in parturient women: A global study

“…Approximately 830 women die from pregnancy or birth-related complications globally every day 1 , with postpartum haemorrhage (PPH) being the major cause 2 . The incidence of PPH is difficult to quantify due to different definitions and methods used to estimate blood loss, but recent large studies, where PPH is defined as a blood loss of ≥ 500 millilitres (ml), report a PPH rate of 1.2-9% [3][4][5][6][7] , with the highest rates in sub-Saharan Africa 7 . Variations in the inclusion and exclusion criteria of these studies may also contribute to disparity in the PPH rates.…”

“…Massive or severe PPH is defined variously as a blood loss ≥ 1,000 ml 4,7,8 or ≥ 1,500 ml 9,10 ; bleeding requiring a blood transfusion 5 ; or bleeding requiring ≥ 8 bags of red blood cells 11,12 . The average rate for severe PPH is 1.2%, with a range of 0.02-4.5%, depending on how PPH is defined 4,5,[7][8][9][10][11][12] . The most common cause of severe PPH, responsible for 27% of all maternal deaths 2 , is uterine atony, which is the failure of the uterus to contract after the birth of a baby 4 .…”

“…The average rate for severe PPH is 1.2%, with a range of 0.02-4.5%, depending on how PPH is defined 4,5,[7][8][9][10][11][12] . The most common cause of severe PPH, responsible for 27% of all maternal deaths 2 , is uterine atony, which is the failure of the uterus to contract after the birth of a baby 4 . Consequently, to stimulate contractions, active management of the third stage of labour and use of oxytocin are widely recommended for PPH prophylaxis 13 .…”

Poor Uterine Contractility as Maternal Predisposition to Postpartum Hemorrhage Among Low-Risk Women: An Analysis of Large-Scale Database

“…These risk factors could be identi ed by maternal medical history, maternal check-ups, or ultrasound examinations before labor starts. Meanwhile, the most common etiology of PPH was uterine atony [11,12], which accounts for 70%-80% of PPH cases [13,14]. Seemingly obstetrically low-risk women who do not have any of the above-mentioned risk factors may suddenly develop atonic PPH.…”

Digital Scales of Web-Based Partograph in Detecting the Early Postpartum Bleeding

“…The percentages were related with the use of partograph sheets atthe second stage of labor, active management at the third stage which is very important in preventing bleeding around 60-70%, including administration of oxytocin, controlled cord stretching and uterine fundal massage. Furthermore, monitoring the IV stage until 2 hours of postpartum include: pulse, blood pressure, bladder, temperature, and bleeding period is the most urgent thing to prevent maternal and infant mortality (Adnan, 2017;Rani & Begum, 2017;Sentilhes et al, 2015;Egenberg, 2017;Guasch & Gilsanz, 2016;Herrick, Mvundura, Burke, & Abu-Haydar,2017;Nyflot et al, 2017;Francoise et al,2016;Mobeen et al, 2010;Mezmur, 2017;Mandiwa, 2017;Zalalem, 2017).…”