Hospital Characteristics and Other Factors Associated with the Risk of Postpartum Hemorrhage in the United States

Real-World Utilization of an Intrauterine, Vacuum-Induced, Hemorrhage-Control Device

“…16,18 In addition, the racial and ethnic diversity of our PPH population was similar to that reported in a nationally representative health care database of more than 1.6 million pregnant individuals across 463 U.S. hospitals, which includes Medicaid, and the National Inpatient Sample database, which is the largest publicly available U.S. all-payer inpatient care database. 22,23…”

“…16,18 In addition, the racial and ethnic diversity of our PPH population was similar to that reported in a nationally representative health care database of more than 1.6 million pregnant individuals across 463 U.S. hospitals, which includes Medicaid, and the National Inpatient Sample database, which is the largest publicly available U.S. all-payer inpatient care database. 22,23 Limitations include that recruitment was largely at academic centers, which could affect generalizability to rural, community, or limited-resource settings. In addition, the blood loss data were comprised of a mix of estimated and quantitative reporting and should be interpreted under the context of institutional variability in assessment and quantification methods.…”

A Nationwide Study of the “July Effect” Concerning Postpartum Hemorrhage and Its Risk Factors at Teaching Hospitals across the United States

“…These findings have implications for improving the teaching and care environments in teaching hospitals. Though it should be noted that not all trainees at the same level demonstrate the same knowledge and skills, medical schools must warrant that new interns and residents are trained and prepared with new protocols and practices before taking on new roles in the clinical setting, and that should be continued through the changeover [ 16 ]. The findings suggest careful assessment of collected data to evaluate and investigate the third stage of labor outcomes regarding PPH in the early and late academic year to institute more rigorous roles and protocols regarding the supervision of new trainees and prevent adverse obstetric care outcomes [ 21 ].…”

“…Therefore, it is critical to scrutinize whether a higher incidence of PPH is related to residents’ work hours, defective procedural techniques, or overall preprocedural care and unfamiliarity with hospital procedures and practices [ 30 ]. It is important to note that improving monitoring and practical clinical training are essential to mitigate the impacts of changeover [ 16 ]. In addition, more research is needed to focus on medication errors, delayed or incorrect diagnoses, and the vulnerabilities of patients to adverse outcomes.…”

“…Some studies observed increased adverse patient outcomes or inefficient care during this transition, known as the “July effect” [ 13 , 14 , 15 ]. A previous study using 2018 Nationwide Inpatient Sample (NIS) data to examine the association of the risk of PPH with hospital characteristics found that teaching hospitals across the U.S. had the highest adjusted odds of increased risks of PPH [ 16 ]. Therefore, the same data (the NIS 2018 data) was used to assess the “July effect” on the increased risks of PPH across U.S. teaching hospitals.…”