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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.

SUBMITTER: Ahmadzia HK

PROVIDER: S-EPMC7375891 | biostudies-literature | 2020 Jul

REPOSITORIES: biostudies-literature

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A national update on rates of postpartum haemorrhage and related interventions.

Ahmadzia Homa K HK Grotegut Chad A CA James Andra H AH

Blood transfusion = Trasfusione del sangue 20200515 4

<h4>Background</h4>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.<h4>Material and methods</h4>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 ...[more]

PMID: 32530404

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Project description:BackgroundPostpartum haemorrhage (PPH) remains a leading cause of maternal mortality. Many trials assessing interventions to prevent PPH base their data on low risk women. It is important to consider the impact data collection methods may have on these results. This review aims to assess trials of PPH prophylaxis by grading trials according to the degree of risk status of the population enrolled in these trials and identify differences in the PPH rates of low risk and high risk populations.MethodsSystematic review and meta-analysis using a random-effects model. Trials were identified through CENTRAL. Trials were assessed for eligibility then graded according to antenatal risk factors and method of birth into five grades. The main outcomes were overall trial rate of minor PPH (blood loss ≥500 ml) and major PPH (> 1000 ml) and method of determining blood loss (estimated/measured).ResultsThere was no relationship between minor or major PPH rate and risk grade (Kruskal-Wallis: minor - T = 0.92, p = 0.82; major - T = 0.91, p = 0.92). There was no difference in minor or major PPH rates when comparing estimation or measurement methods (Mann-Whitney: minor - U = 67, p = 0.75; major - U = 35, p = 0.72). There was however a correlation between % operative births and minor PPH rate, but not major PPH (Spearman r = 0.32 v. Spearman r = 0.098).ConclusionsUsing data from trials using low risk women to generalise best practice guidelines might not be appropriate for all births, particularly complex births. Although complex births contribute disproportionately to PPH rates, this review showed they are often underrepresented in trials. Despite this, there was no difference in reported PPH rates between studies conducted in high and low risk groups. Method of birth was shown to be an important risk factor for minor PPH and may be a better predictor of PPH than antenatal risk factors. Women with operative births are often excluded from trials meaning a lack of data supporting interventions in these women. More focus on complex births is needed to ensure the evidence base is relevant to the target population.

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A national update on rates of postpartum haemorrhage and related interventions.

Publications

A national update on rates of postpartum haemorrhage and related interventions.

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