Impact of efforts to prevent maternal deaths due to obstetric hemorrhage on trends in epidemiology and management of severe postpartum hemorrhage in Japan: a nationwide retrospective study

Abstract

Background The Japan Society of Obstetrics and Gynecology and the Japan Association of Obstetricians and Gynecologists have issued the guidelines and recommendations on postpartum hemorrhage since 2010 and have been conducted widespread educational activities from 2012. The aim of this study was to investigate the impact of these efforts by the Societies to prevent maternal deaths due to obstetric hemorrhage on trends in epidemiology and management of severe postpartum hemorrhage in Japan. Methods A national retrospective cohort study was conducted using the national database of health insurance claims for the period 2012 and 2018. The subjects were all insured women who received a blood transfusion for postpartum hemorrhage. The primary endpoints of this study were hysterectomy and maternal mortality. The etiology of hemorrhage, treatment facility, type of procedure, and blood transfusion volume were tabulated. Results Women with postpartum hemorrhage that underwent transfusion increased from 3.5 to 5.5 per 1000 deliveries between 2012 and 2018. The most common cause of postpartum hemorrhage was atonic hemorrhage. After insurance coverage in 2013, the intrauterine balloon tamponade use increased to 20.3% of postpartum hemorrhages treated with transfusion in 2018, while the proportion of hysterectomy was decreased from 7.6% (2013–2015) to 6.4% (2016–2018) (p < 0.0001). The proportion of postpartum hemorrhage in maternal deaths decreased from 21.1% (2013–2015) to 14.1% (2016–2018) per all maternal deaths cases (p = 0.14). Cases with postpartum hemorrhage managed in large referral hospitals was increased (65.9% in 2012 to 70.4% in 2018) during the study period (p < 0.0001). Conclusions The efforts by the Societies to prevent maternal mortality due to obstetric hemorrhage resulted in a significant decrease in the frequency of hysterectomies and a downward trend in maternal mortality due to obstetric hemorrhage.

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Cost-effectiveness analysis of carbetocin for prevention of postpartum hemorrhage in a low-burden high-resource city of China

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Impact of maternal late hospital arrival on adverse outcome of offspring affected by placental abruption: A regional multicenter nested case–control study in Japan

“…Placental abruption is a life‐threatening obstetrical emergency that influences maternal and neonatal morbidity and mortality. It is defined as the complete or partial premature separation of the placenta from the uterine wall before delivery and has been estimated to occur in 0.3%–1.0% of all pregnancies 1–3 . Various risk factors of placental abruption have been reported thus far, including advanced maternal age, cigarette smoking, maternal hypertension such as preeclampsia, premature rupture of membranes, chorioamnionitis, and oligohydramnios 4 …”

“…It is defined as the complete or partial premature separation of the placenta from the uterine wall before delivery and has been estimated to occur in 0.3%-1.0% of all pregnancies. [1][2][3] Various risk factors of placental abruption have been reported thus far, including advanced maternal age, cigarette smoking, maternal hypertension such as preeclampsia, premature rupture of membranes, chorioamnionitis, and oligohydramnios. 4 At present, there are no established methods of predicting or preventing placental abruption, thus probably the only effective solution to improve neonatal hypoxic-ischemic morbidity and mortality is early intervention for that pregnancy, namely, the prompt clinical diagnosis of placental abruption and emergency cesarean section.…”