Regional differences in severe postpartum hemorrhage: a nationwide comparative study of 1.6 million deliveries

Prick, Babette W.; Altenstadt, Joost F. von Schmidt auf; Hukkelhoven, Chantal W.P.M.; Bonsel, Gouke J.; Steegers, Eric A.P.; Mol, Ben Willem J.; Schutte, Joke M.; Bloemenkamp, Kitty W. M.; Duvekot, Johannes J.

doi:10.1186/s12884-015-0473-8

Cited by 19 publications

(18 citation statements)

References 42 publications

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“…This is comparable with the literature where international prevalences of severe PPH varied from 0Á3 to 5Á1% (Africa) to 0Á7 to 2Á7% (Asia) and 1Á7 to 5Á5% (Europe) [7,8]. Consistent with other literature, we found regional differences in incidence of severe PPH in our retrospective study (Figure 1) [6,9]. This variation could not be explained by maternal and pregnancy characteristics, medical interventions or healthcare setting.…”

Section: Epidemiologysupporting

confidence: 92%

“…To measure the incidence of severe PPH in the Netherlands, we performed a retrospective study on prospectively collected data of all deliveries registered in the Netherlands Perinatal Registry in the period 2000-2008. We reported a national incidence of severe PPH (defined as ≥1000 ml blood loss) of 4Á5% of all deliveries for this period [6]. This is comparable with the literature where international prevalences of severe PPH varied from 0Á3 to 5Á1% (Africa) to 0Á7 to 2Á7% (Asia) and 1Á7 to 5Á5% (Europe) [7,8].…”

Section: Epidemiologysupporting

confidence: 86%

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Transfusion triggers in patients with postpartum haemorrhage

Prick

Duvekot

Rhenen

et al. 2016

ISBT Science Series

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Postpartum haemorrhage (PPH) is one of the top five causes of maternal mortality both in developed and developing countries. In the Netherlands, we reported an incidence of severe PPH (defined as ≥1000 ml blood loss) of 4Á5% in the period 2000-2008. As the majority of women who experience PPH have no identifiable clinical or historical risk factors, all women must be considered at risk and active third-stage management is recommended in all women to prevent PPH. Red blood cell (RBC) transfusion is often necessary in the treatment of women who suffered from PPH. However, the current awareness of transfusion-related complications (blood-borne infections, transfusion reactions and immunologic effects) and the cost prompted a re-evaluation of the transfusion practice. With only small differences in physical fatigue scores and no differences in secondary outcomes, we recommend implementation of a restrictive transfusion policy for women with PPH without severe anaemic complaints. This restrictive transfusion policy saves €438 per woman compared to a liberal transfusion policy. In addition, we recommend implementation of health-related quality of life scores for counselling and decision-making in clinical practice regarding transfusion policy after PPH.

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Section: Epidemiologysupporting

confidence: 92%

Section: Epidemiologysupporting

confidence: 86%

Transfusion triggers in patients with postpartum haemorrhage

Prick

Duvekot

Rhenen

et al. 2016

ISBT Science Series

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“…Postpartum haemorrhage is the leading cause of almost a quarter of all maternal deaths worldwide . The incidence of severe primary PPH (≥1000 mL blood loss within 24 h postpartum) in the general Dutch population is 4.5% . In a previous study of our group, 51% of women with moderate and severe VWD self‐reported PPH ; other studies documented an incidence of 20–40% in VWD and carriers of haemophilia .…”

Section: Introductionmentioning

confidence: 51%

Primary postpartum haemorrhage in women with von Willebrand disease or carriership of haemophilia despite specialised care: a retrospective survey

Stoof¹,

et al. 2015

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Pregnant women with bleeding disorders require specialised peripartum care to prevent postpartum haemorrhage (PPH). If third trimester coagulation factor levels are <0.50 IU mL(-1) , prophylactic treatment is indicated and administered according to international guidelines. However, optimal dose and duration are unknown and bleeding may still occur. The aim of this study was to investigate the outcome in women with von Willebrand disease (VWD) or haemophilia carriership treated according to current practice guidelines. From the period 2002-2011, 185 deliveries in 154 VWD women or haemophilia carriers were retrospectively included. Data on blood loss, bleeding disorder characteristics and obstetric risk factors were obtained. The outcome was primary PPH, defined as blood loss ≥500 mL within 24 h postpartum and severe PPH as blood loss ≥1000 mL. Primary PPH was observed in 62 deliveries (34%), 14 (8%) of which resulted in severe PPH. In 26 deliveries prophylactic treatment was administered due to factor levels below the 0.50 IU mL(-1) cut-off in the third trimester, 14 of which (54%) were complicated by PPH. We found an increased PPH risk in deliveries given prophylactic treatment compared with deliveries without (OR 2.7, 95% CI 1.2-6.3). In conclusion, PPH incidence was highest in deliveries with the lowest factor levels in the third trimester. Currently, delivery outcome in women with bleeding disorders is unsatisfactory, given the high PPH incidence despite specialised care. Future studies are required to optimise management of deliveries in this patient population.

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“…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 .…”

Section: Introductionmentioning

confidence: 99%