Epidemiological investigation of a temporal increase in atonic postpartum haemorrhage: a population‐based retrospective cohort study

Abstract

ObjectiveIncreases in atonic postpartum haemorrhage (PPH) have been reported from several countries in recent years. We attempted to determine the potential cause of the increase in atonic and severe atonic PPH.DesignPopulation-based retrospective cohort study.SettingBritish Columbia, Canada, 2001–2009.PopulationAll women with live births or stillbirths.MethodsDetailed clinical information was obtained for 371 193 women from the British Columbia Perinatal Data Registry. Outcomes of interest were atonic PPH and severe atonic PPH (atonic PPH with blood transfusion ≥1 unit; atonic PPH with blood transfusion ≥3 units or procedures to control bleeding), whereas determinants studied included maternal characteristics (e.g. age, parity, and body mass index) and obstetrics practice factors (e.g. labour induction, augmentation, and caesarean delivery). Year-specific unadjusted and adjusted odds ratios for the outcomes were compared using logistic regression.Main outcome measuresAtonic PPH and severe atonic PPH.ResultsAtonic PPH increased from 4.8% in 2001 to 6.3% in 2009, atonic PPH with blood transfusion ≥1 unit increased from 16.6 in 2001 to 25.5 per 10 000 deliveries in 2009, and atonic PPH with blood transfusion ≥3 units or procedures to control bleeding increased from 11.9 to 17.6 per 10 000 deliveries. The crude 34% (95% CI 26–42%) increase in atonic PPH between 2001 and 2009 remained unchanged (42% increase, 95% CI 34–51%) after adjustment for determinants of PPH. Similarly, adjustment did not explain the increase in severe atonic PPH.ConclusionsChanges in maternal characteristics and obstetric practice do not explain the recent increase in atonic and severe atonic PPH.

What is the optimal duration of oral misoprostol treatment for cervical ripening?

“…By contrast, the status of the membranes at the time of initiation of cervical ripening was not associated with a higher risk of cesarean section, which is in contradiction with the results of previous studies [32,33]. Regarding maternal and neonatal side effects and complications, we showed that the use of misoprostol was not associated with severe complications except a high percentage of post-partum hemorrhage, which is comparable to the one described in a recent review paper [34].…”

In Vitro Fertilization Pregnancy is One of the Risk Factor for Atonic Bleeding in Problem-Free Pregnancy

“…Under this situation, we foresee an intranatal trouble beforehand, and it is important to be able to deal quickly. PPH has recently been increasing worldwide [2,[33][34][35] and it has been reported that there are racial differences [4]. However, these reports do not provide any definitive reasons.…”

“…Recently, there have been many reports about PPH, which has increased in incidence worldwide with the reason remaining unclear [2,3].…”

Fibrin-based clot formation as an early and rapid biomarker for progression of postpartum hemorrhage: a prospective study

“…The incidence of bleeds .2500 mL (6/1000) was similar to a recent confidential audit (5.9/1000) 4 and the proportion transfused comparable to national reports. 6,8,[23][24][25][26] Women were managed on routine protocols and had received variable amounts of crystalloid and colloid before inclusion; therefore, the results are applicable to many maternity units and different clinical situations. Limitations are that blood loss at study enrolment is difficult to quantify and that, although the Fibtem result was not known by the clinicians, they could react to the fibrinogen result when it became available.…”

“…2 The incidence of PPHs .2500 mL is increasing in many countries, [3][4][5][6] and PPH accounts for 75% of severe childbirth-related morbidity. 4 PPH results from a combination of physical causes such as uterine atony or placental adherence or abruption and is often exacerbated by hemostatic impairment.…”