Postpartum hemorrhage with transfusion: Trends, near misses, risk factors and management at the scale of a perinatal network

Marocchini, Michael; Lauferon, Juliette; Quantin, Catherine; Shrivastava, Paul

doi:10.1016/j.jogoh.2017.03.011

Cited by 20 publications

(19 citation statements)

References 23 publications

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“…Furthermore, the incidence of PPH also depends on prevalence of risk factors in the population. Our findings confirm previous observations that increased maternal age (≥ 35 years), previous cesarean birth, multiple pregnancy, pre‐eclampsia, labor induction, and instrumental or cesarean birth are associated with major PPH . These antepartum risk factors were only present in a certain number of women enduring major PPH.…”

Section: Discussionsupporting

confidence: 90%

“…The MBRRACE‐UK reports (Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK) are likely to have contributed to a steady fall of obstetric hemorrhage‐related deaths in the UK and provide a rational framework for how national surveillance may be applied by other countries . Nevertheless, the escalating rates of PPH in other high‐income countries emphasize the importance of nationwide studies into obstetric hemorrhage‐related maternal morbidity and mortality . International comparison of data regarding PPH that led to massive transfusion could reveal variations in management and outcome between countries, and consequently lead to improvements in maternal care.…”

Section: Discussionmentioning

confidence: 99%

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Women receiving massive transfusion due to postpartum hemorrhage: A comparison over time between two nationwide cohort studies

Ramler

Akker

Henriquez

et al. 2019

Acta Obstet Gynecol Scand

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Introduction Incidence of massive transfusion after birth was high in the Netherlands between 2004 and 2006 compared with other high‐income countries. This study investigated incidence, causes, management and outcome of women receiving massive transfusion due to postpartum hemorrhage in the Netherlands in more recent years. Material and methods Data for all pregnant women who received eight or more units of packed red blood cells from a gestational age of 20 weeks and within the first 24 hours after childbirth, during 2011 and 2012, were obtained from a nationwide retrospective cohort study, including 61 hospitals with a maternity unit in the Netherlands. Results Incidence of massive transfusion due to postpartum hemorrhage decreased to 65 per 100 000 births (95% CI 56‐75) between 2011 and 2012, from 91 per 100 000 births (95% CI 81‐101) between 2004 and 2006, while median blood loss increased from 4500 mL (interquartile range 3250‐6000) to 6000 mL (interquartile range 4500‐8000). Uterine atony remained the leading cause of hemorrhage. Thirty percent (53/176) underwent peripartum hysterectomy between 2011 and 2012, compared with 25% (83/327) between 2004 and 2006. Case fatality rate for women who received massive transfusion due to postpartum hemorrhage was 2.3% (4/176) between 2011 and 2012, compared with 0.9% (3/327) between 2004 and 2006. Conclusions The incidence of postpartum hemorrhage with massive transfusion decreased in the Netherlands between both time frames, but remained an important cause of maternal mortality and morbidity, including peripartum hysterectomy. National surveillance of maternal morbidity and mortality due to postpartum hemorrhage through an improved and continuous registration with confidential enquiries may lead to the identification of clear improvements of maternal care.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Women receiving massive transfusion due to postpartum hemorrhage: A comparison over time between two nationwide cohort studies

Ramler

Akker

Henriquez

et al. 2019

Acta Obstet Gynecol Scand

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“…However, a few studies reported the protective effect of cesarean section against PPH when compared with vaginal births [30]. Our study showed that the risk of SPPH elevated significantly for women with placenta previa, placental abruption and PAS, which was consistent with previous studies [4,[9][10][11][19][20][21]. Placenta related factors contributed significantly to severe forms of PPH, such as PPH with blood transfusion and PPH with hysterectomy.…”

Section: Risk Factors For Spphsupporting

confidence: 91%

“…The risk factors for SPPH were maternal age<18y, previous cesarean section, history of PPH, conception through IVF, pre-delivery anemia, stillbirth, prolonged labor, placenta previa, placental abruption, PAS and macrosomia. Previous cesarean section, pre-delivery anemia, stillbirth, prolong labor and macrosomia were associated with SPPH, which were compatible with previous reports [4,[9][10][11][19][20][21]. With antenatal anemia affecting up to 25% pregnant women, initiatives may be necessary to promote anemia correction [22].…”

Section: Risk Factors For Spphsupporting

confidence: 87%

Prevalence and Risk Factors of Severe Postpartum Hemorrhage: a Retrospective Cohort Study

Liu

et al. 2020

Preprint

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Background: Although maternal deaths are rare in developed regions, the morbidity associated with severe postpartum hemorrhage remains a major problem. To provide new insight into severe postpartum hemorrhage, we analyzed data of women giving birth in Guangzhou Medical Centre for Critical Pregnant Women, which receiveda large quantity of critically ill obstetric patients from other hospitals of Southern China. Methods: In this study, we conducted a retrospective cohort by using the criteria of severe maternal morbidities, which was defined by estimation of blood loss volume and use of blood transfusion≥4 units, to determine the prevalence, risk factors and short-term complications of severe postpartum hemorrhage. Results: Severe postpartum hemorrhage was observed in 532 mothers (1.56%) among the total population of 34 178 mothers. Placental related cause (55.83%) was the major identified cause of severe postpartum hemorrhage, while uterine atony without associated retention of placental tissues accounted for 38.91%. The risk factors for severe postpartum hemorrhage were maternal age<18 years, previous cesarean section, history of postpartum hemorrhage, conception through in vitro fertilization, pre-delivery anemia, stillbirth, prolonged labor, placenta previa, placental abruption, placenta accrete spectrum and macrosomia. The prevalence rates of admission to ICU, hysterectomy, acute renal failure and sepsis were significantly higher in women with severe postpartum hemorrhage. Conclusion:The results of this study suggested that severe postpartum hemorrhagecould be adopted as an indicator to assess the quality of obstetric care because of its severity and potential lethality. Extra vigilance during the antenatal and peripartum periods is needed to identify women who have risk factors and enable early intervention to prevent severe postpartum hemorrhage. It’s important to remember that we have to prepare for all mothers giving birth, as some get severe postpartum hemorrhagewithout any known risk factors.

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“…Eight studies showed a strong association between multiple pregnancy and severe bleeding. 14 -21 , 22 - 23 These results met the criteria of strength, consistency, plausibility, and coherence. Multiple pregnancy was considered as a key established determinant of S-PPH.…”

Section: Course Of Pregnancy Multiple Pregnancymentioning

confidence: 78%

Factors associated with severe postpartum haemorrhage: systematic review using Bradford Hill’s causality framework

Stachetti¹,

Spodenkiewicz²,

Winer³

et al. 2019

Journal of Global Health Reports

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Back Background ground Severe postpartum haemorrhage (S-PPH) is the leading cause of maternal death worldwide. We aimed to provide an up-to-date summary about S-PPH determinants. Methods Methods We performed a systematic review following the Preferred Reporting Items for Systematic reviews and Meta-analysis (PRISMA) guidelines. We searched the terms "risk factor", "determinant", "post-partum haemorrhage" and "severe", within Web of Science, Scopus, Science Direct, Medline, Cochrane, and Clinical Trials.gov databases. The primary endpoint was S-PPH, defined as a blood loss ≥1,000 mL a second-line treatment, a PPH-related blood transfusion, a peripartum decrease in haemoglobin level or a PPH-related maternal death. All interventional and observational studies about risks factors for S-PPH published in English or French between January 1, 2004 and August 31, 2018 were eligible. Because studies used very different definitions of S-PPH, meta-analysis was ruled out and we gauged the risk factors using the Bradford Hill's criteria causality framework. R Results esults Amongst 1,193 identified abstracts, we selected fourteen studies that collected information on 9,271,519 parturient women (35,825 with S-PPH). Key established determinants of S-PPH were previous PPH, previous caesarean, multiple pregnancy, abnormal placentation, preeclampsia, labour induction, prolonged labour, placental retention, uterine rupture, uterine atony, uterine fibroids, macrosomia, birth canal injuries, instrumental vaginal and caesarean deliveries. Most of associated factors of uncertain significance belonged to socio-environmental characteristics. Biological parameters were all classified as indicators of risk. C Conclusions onclusions The key established determinants of S-PPH are of primarily obstetrical nature. New avenues of research, including contextual studies, are needed to improve the management of severe obstetrical morbidity.

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Postpartum hemorrhage with transfusion: Trends, near misses, risk factors and management at the scale of a perinatal network

Cited by 20 publications

References 23 publications

Women receiving massive transfusion due to postpartum hemorrhage: A comparison over time between two nationwide cohort studies

Women receiving massive transfusion due to postpartum hemorrhage: A comparison over time between two nationwide cohort studies

Prevalence and Risk Factors of Severe Postpartum Hemorrhage: a Retrospective Cohort Study

Factors associated with severe postpartum haemorrhage: systematic review using Bradford Hill’s causality framework

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