A national update on rates of postpartum haemorrhage and related interventions

Abstract

Background - Postpartum haemorrhage (PPH) is still a leading cause of maternal morbidity in the US. We aimed to reassess national trends in severe and non-severe PPH using recent data.
Material and methods - We performed a cross-sectional study using the 2001-2012 Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project. Delivery-related hospitalisations with PPH were identified using the International Classification of Diseases (9th revision).  Rates were calculated per 1,000 delivery hospitalisations. All statistical analyses accounted for the complex sampling design of the data source.
Results - Rates of non-severe PPH did not change significantly from 2001-2002 to 2011-2012 (25.5 and 24.2 per 1,000; p=0.058). The rates of PPH requiring blood transfusions for caesarean deliveries more than doubled in this time period from 2.0 to 4.8 (p<0.001). The overall rate of PPH with a procedure other than blood transfusion has risen from 0.9 to 1.9. Specifically, rates of hysterectomy (0.5 to 0.7; p<0.001), embolisation (0.3 to 0.5; p<0.001), and uterine tamponade use (0.09 to 0.69; p<0.001) increased over the time period.
Discussion - Population-based surveillance data show an increasing rate of only severe PPH in the US. Rates of medical/surgical intervention including hysterectomy, embolisation and uterine tamponade use are also rising.