Trends in postpartum hemorrhage from 2000 to 2009: a population-based study

Azar Mehrabadi, Jennifer A Hutcheon, Lily Lee, Robert M Liston, K S Joseph, Azar Mehrabadi, Jennifer A Hutcheon, Lily Lee, Robert M Liston, K S Joseph

Abstract

Background: Postpartum hemorrhage, a major cause of maternal death and severe maternal morbidity, increased in frequency in Canada between 1991 and 2004. We carried out a study to describe the epidemiology of postpartum hemorrhage in British Columbia, Canada, between 2000 and 2009.

Methods: The study population included all women residents of British Columbia who delivered between 2000 and 2009. Data on postpartum hemorrhage by subtypes and severity were obtained from the British Columbia Perinatal Data Registry. Among women with postpartum hemorrhage, severe cases were identified by the use of blood transfusions or procedures to control bleeding. Rates of postpartum hemorrhage and changes over time were assessed using rates, rate ratios and 95% confidence intervals (CI).

Results: The rate of postpartum hemorrhage increased by 27% (95% CI 21-34%) between 2000 and 2009 (from 6.3% to 8.0%), while atonic postpartum hemorrhage rates increased by 33% (95% CI 26-41%) from 4.8% to 6.4%. Atonic postpartum hemorrhage with blood transfusion increased from 17.8 to 25.5 per 10,000 deliveries from 2000 to 2009 and atonic postpartum hemorrhage with either suturing of the uterus, ligation of pelvic vessels or embolization increased from 1.8 to 5.6 per 10,000 deliveries from 2001 to 2009. The increase in atonic postpartum hemorrhage was most evident between 2006 and 2009 and occurred across regions, hospitals and various maternal, fetal and obstetric characteristics.

Conclusions: Atonic postpartum hemorrhage and severe atonic postpartum hemorrhage increased in British Columbia between 2000 and 2009. Further research is required to identify the cause of the increase.

Figures

Figure 1
Figure 1
Temporal trends in postpartum hemorrhage (PPH) by subtype (Figure1A), and severe PPH and severe atonic PPH (Figure1B). Smoothed rates with 95% confidence interval are overlaid on observed semi-annual rates.

References

    1. Wise A, Clark V. Strategies to manage major obstetric haemorrhage. Curr Opin Anaesthesiol. 2008;21(3):281–287. doi: 10.1097/ACO.0b013e3282f8e257.
    1. Roberts WE. Emergent obstetric management of postpartum hemorrhage. Obstet Gynecol Clin North Am. 1995;22(2):283–302.
    1. Knight M, Callaghan WM, Berg C, Alexander S, Bouvier-Colle MH, Ford JB, Joseph KS, Lewis G, Liston RM, Roberts CL. et al.Trends in postpartum hemorrhage in high resource countries: a review and recommendations from the International Postpartum Hemorrhage Collaborative Group. BMC Pregnancy Childbirth. 2009;9:55. doi: 10.1186/1471-2393-9-55.
    1. Health Canada. Canadian Perinatal Health Report, 2003. Ottawa: Minister of Public Works and Government Services of Canada; 2003.
    1. Joseph KS, Rouleau J, Kramer MS, Young DC, Liston RM, Baskett TF. Investigation of an increase in postpartum haemorrhage in Canada. BJOG. 2007;114(6):751–759. doi: 10.1111/j.1471-0528.2007.01316.x.
    1. Callaghan WM, Kuklina EV, Berg CJ. Trends in postpartum hemorrhage: United States, 1994–2006. Am J Obstet Gynecol. 2010;202(4):353. e351-e356.
    1. National Service Scotland. Scottish Confidential Audit of Severe Maternal Morbidity: 3rd Annual Report. In. Aberdeen, Scotland. 2005.
    1. Rossen J, Økland I, Bjarte Nilsen O, Eggebø TM. Is There an Increase of Postpartum Hemorrhage, and Is Severe Hemorrhage Associated With More Frequent Use of Obstetric Interventions? Obstet Gynecol Surv. 2011;66(1):18–20. doi: 10.1097/OGX.0b013e31820220bb.
    1. Lutomski JE, Byrne BM, Devane D, Greene RA. Increasing trends in atonic postpartum haemorrhage in Ireland: an 11-year population-based cohort study. BJOG. 2012;119(3):306–314. doi: 10.1111/j.1471-0528.2011.03198.x.
    1. Ford JB, Roberts CL, Simpson JM, Vaughan J, Cameron CA. Increased postpartum hemorrhage rates in Australia. Int J Gynecol Obstet. 2007;98(3):237–243. doi: 10.1016/j.ijgo.2007.03.011.
    1. Kramer MS, Dahhou M, Vallerand D, Liston R, Joseph KS. Risk factors for postpartum hemorrhage: can we explain the recent temporal increase? J Obstet Gynaecol Can. 2011;33(8):810–819.
    1. Bateman BT, Berman MF, Riley LE, Leffert LR. The epidemiology of postpartum hemorrhage in a large, nationwide sample of deliveries. Anesth Analg. 2010;110(5):1368–1373. doi: 10.1213/ANE.0b013e3181d74898.
    1. Say L, Souza JP, Pattinson RC. Maternal near miss–towards a standard tool for monitoring quality of maternal health care. Best Pract Res Clin Obstet Gynaecol. 2009;23(3):287–296. doi: 10.1016/j.bpobgyn.2009.01.007.
    1. Dupont WD, Plummer D. Using Stata v9 to model complex non-linear relationships with restricted cubic splines: North American Stata Users' Group Meeting 2005, Stata Users Group. 2005.
    1. Harrell FE. Regression modeling strategies: with applications to linear models, logistic regression, and survival analysis. New York: Springer; 2001.
    1. Liu S, Joseph KS, Bartholomew S, Fahey J, Lee L, Allen AC, Kramer MS, Sauve R, Young DC, Liston RM. Temporal trends and regional variations in severe maternal morbidity in Canada, 2003 to 2007. J Obstet Gynaecol Can. 2010;32(9):847–855.
    1. Canadian Coding Standards for ICD-10-CA and CCI for 2006.
    1. Nova Scotia Atlee Perinatal Database Report for 2000–2009.
    1. Phaneuf S, Rodriguez Linares B, TambyRaja RL, MacKenzie IZ, Lopez Bernal A. Loss of myometrial oxytocin receptors during oxytocin-induced and oxytocin-augmented labour. J Reprod Fertil. 2000;120(1):91–97.

Source: PubMed

Patrocinadores e Colaboradores

Condições médicas

Intervenções de drogas

3
Se inscrever