Increasing incidence of postpartum hemorrhage: the Dutch piece of the puzzle

Abstract

Introduction. An increase of postpartum hemorrhage (PPH) has been reported in many high-income countries. In addition to this data, this study reports on trends in the incidence of PPH in the Netherlands in 2000-2013, and examines the extent to which temporal changes in risk indicators could explain a possible change in incidence of PPH. Material and methods. We used data from the Dutch Perinatal Registry, which contains prospectively collected antenatal, peripartum and neonatal data of 95-99% of all women and neonates in the Netherlands. We selected births ≥22 weeks of gestation from January 2000 until December 2013. Changes in the incidence of PPH and its risk indicators were studied over time. Main outcome measure was PPH, defined as blood loss >1000 mL within 24 h following delivery. Results. The data comprised 2 406 784 women. The incidence of PPH rose significantly from 4.1% in 2000 to 6.4% in 2013 (p < 0.0001). The incidence of previously identified risk indicators for PPH increased over time. Manual removal of placenta was strongly associated with PPH (OR 29.3, CI 28.8-29.8). The incidence of PPH-related blood transfusion decreased remarkably. Conclusions. In line with international observations, Dutch data suggest a considerable increase in the incidence of PPH which can only partly be explained by the studied risk indicators. The decreasing incidence of obstetric blood transfusion suggests an increased incidence of blood loss of 1000-1500 mL.

Predictive value of a bleeding score for postpartum hemorrhage

“…Postpartum hemorrhage continues to be a leading cause of maternal health problems worldwide . Although risk factors are often known to be present during pregnancy and birth, postpartum hemorrhage frequently occurs unexpectedly .…”

“…Postpartum hemorrhage continues to be a leading cause of maternal health problems worldwide. [1][2][3][4] Although risk factors are often known to be present during pregnancy and birth, postpartum hemorrhage frequently occurs unexpectedly. [5][6][7] Also, women with known risk factors for postpartum hemorrhage frequently do not bleed excessively following childbirth.…”

Major obstetric hemorrhage: a follow-up survey on quality of life of women and their partners

“…Recent reports indicate that the incidence of postpartum hemorrhage (PPH) is increasing worldwide [2][3][4][5][6][7][8][9][10][11][12][13]. The physical impact of MOH has been studied extensively [14]; however hardly any data are available on psychological consequences.…”

Menstrual and obstetrical bleeding in women with inherited platelet receptor defects—A systematic review

“…Known risk factors for PPH such as uterus atony, a prolonged second stage of labour, previous caesarean section and retained placenta, are potential confounders that may have affected our results, yet have been infrequently described . Our data show the ongoing risk of PPH for women receiving prophylactic treatment of 54.2% (32/59), compared with a PPH incidence of 73.7% (14/19) in the non‐prophylactic group, with both incidences being much higher than currently seen in the general population . Although the number of included deliveries is small, these data indicate that more women might benefit from prophylactic treatment and that current prophylaxis might be insufficient to prevent PPH.…”