Postpartum Hemorrhage Trends and Outcomes in the United States, 2000–2019

Abstract

To analyze temporal trends in and risk factors for postpartum hemorrhage and to analyze the association of risk factors with postpartum hemorrhagerelated interventions such as blood transfusion and peripartum hysterectomy.METHODS: This repeated cross-sectional study analyzed delivery hospitalizations from 2000 to 2019 in the National (Nationwide) Inpatient Sample. Trends analyses were conducted using joinpoint regression to estimate the average annual percent change (AAPC) with 95% CIs. Unadjusted and adjusted survey-weighted logistic regression models were performed to evaluate the relationship between postpartum hemorrhage risk factors and likelihood of 1) postpartum hemorrhage, 2) postpartum hemorrhage that requires blood transfusion, and 3) peripartum hysterectomy in the setting of postpartum hemorrhage, with unadjusted odds ratios and adjusted odds ratios with 95% CIs as measures of association. RESULTS:Of an estimated 76.7 million delivery hospitalizations, 2.3 million (3.0%) were complicated by postpartum hemorrhage. From 2000 to 2019, the rate of

Improving Health Care Responses to Obstetric Hemorrhage

“…Obstetric hemorrhage is one of the most common complications of childbirth. While maternal mortality in the United States attributable to obstetric hemorrhage has been decreasing, the incidence of hemorrhage continues to rise from 2.7% to 4.3% between 2000 and 2019 1–3. Globally similar trends are seen with decreasing mortality and increased incidence of hemorrhage 3…”

“…While maternal mortality in the United States attributable to obstetric hemorrhage has been decreasing, the incidence of hemorrhage continues to rise from 2.7% to 4.3% between 2000 and 2019. [1][2][3] Globally similar trends are seen with decreasing mortality and increased incidence of hemorrhage. 3 With this increasing incidence of obstetrical hemorrhage, maternal morbidity rates of severe maternal morbidity (SMM) have increased.…”

“…These include formal Centers for Disease Control (CDC) definitions including transfusion and hysterectomy 2 but also clinically significant issues arising from acute blood loss, including hypovolemia, transfusionrelated reactions, thromboembolic events, pituitary necrosis, infertility secondary to hysterectomy, and increased psychological stress. [2][3][4] Efforts at decreasing hemorrhagerelated morbidity and mortality are well-described. Within the United States, state-level and hospital-level quality improvement initiatives have noted significant decreases in maternal mortality and SMM as well as the reduction in racial disparities in care for hemorrhage.…”

“…With this increasing incidence of obstetrical hemorrhage, maternal morbidity rates of severe maternal morbidity (SMM) have increased. These include formal Centers for Disease Control (CDC) definitions including transfusion and hysterectomy2 but also clinically significant issues arising from acute blood loss, including hypovolemia, transfusion-related reactions, thromboembolic events, pituitary necrosis, infertility secondary to hysterectomy, and increased psychological stress 2–4…”

Foreword: Postpartum Hemorrhage

“…Hemorrhage is the leading cause of maternal death worldwide, with two thirds of these occurring in the postpartum period 1. In the United States, postpartum hemorrhage occurs in 3% to 5% of deliveries and is the fifth leading cause of maternal mortality 2,3. Postpartum hemorrhage also accounts for a significant amount of severe maternal morbidity that may have significant short-term and long-term consequences to an individual’s health.…”