Increasing Incidence of Postpartum Hemorrhage: The Dutch Piece of the Puzzle

Abstract

(Acta Obstet Gynecol Scand. 2016;95(10):1104–1110) While globally, the maternal mortality ratio has decreased since 1990, the incidence of postpartum hemorrhage has risen in high resource countries such as the United States, Canada, Australia, and Norway. Previous studies have linked the rising incidence of postpartum hemorrhage (PPH), a leading cause of maternal morbidity and mortality, to several possible risk factors, including previous cesarean section, emergency or planned cesarean section, and obesity. This study used data from 2000 to 2013 in the Netherlands to examine the incidence of PPH and the relationship between the incidence of PPH and potential causal factors.

Is the increase in postpartum hemorrhage after vaginal birth because of altered clinical practice?: A register‐based cohort study

“…Birthweight >4000 g was associated with severe PPH in this study. A high birthweight is a well‐known risk factor for PPH, similar to advanced gestational age, 7,9,10 which was also demonstrated in this study.…”

“…Vaginal tearing is rarely measured or discussed in the scientific literature and may therefore be underestimated in general. It is well known that genital tract tears are associated with severe PPH as it is included as one of the four classical causes of severe PPH uterine atony, genital tract tears, retained placenta, and coagulation disorders 10,14,17 . As genital tract tears have a strong association with PPH, timely identification and management by the birth attendant may reduce the amount of PPH.…”

“…The potential covariates for the adjusted analysis were selected from already‐known risk factors described in the literature 3,7,10‐14,17,30 . Furthermore, year of birth was included in the adjusted analysis as the study period covered 9 years during which clinical practice may have changed.…”

“…Postpartum hemorrhage may be unpredictable, and several studies have found that the condition is more common in women at advanced age with a high body mass index (BMI), and in multiparous women 3,7‐12 . Obstetric interventions such as induction of labor, augmentation of labor, and instrumental birth increase the risk of PPH 8,10,11,13,14 . Furthermore, uterine atony, genital tract tears, retained placenta, and coagulation disorders are also known to increase the risk for PPH 6,7,15‐17 .…”

Incidence, Trends and Severity of Primary Postpartum Haemorrhage in Australia: A Population-based Study Using Victorian Perinatal Data Collection Data for 764,244 Births

“…The incidence of PPH is reported to have increased in recent decades, both in Australia (6,7) and other high resource countries. (8)(9)(10) The incidence of severe PPH (10)(11)(12)(13) and of morbidities associated with major blood loss are also rising. (4,7,(9)(10)(11)(14)(15)(16) Rates of peripartum hysterectomy associated with PPH rose in Victoria, Australia between 1999-2002.…”