Trends and outcomes of postpartum haemorrhage, 2003-2011

Abstract

Background: While rates of postpartum haemorrhage (PPH) have continued to rise, it is not clear if the association with other morbidity and transfusion has changed over time. This study explores the recent trend in postpartum haemorrhage and risk factors for transfusion and other severe adverse maternal outcomes following postpartum haemorrhage, stratified by mode of delivery. Methods: Linked birth and hospital data were used to examine ICD-10AM coded PPH and outcomes in maternal birth admission records, 2003-2011 in hospitals in New South Wales (NSW), Australia (N= 818,965 singleton pregnancies). Trends were calculated on the whole population, and among subgroups, and tested using the Cochran Armitage test for trend. Logistic regression models were developed separately for vaginal and caesarean births, and for a maternal morbidity composite indicator (excluding transfusion) and red cell transfusion. Adjusted odds ratios (aOR) for yearly change and 95% confidence intervals (CI) are presented. Adjustment included maternal (eg. age, country of birth) and pregnancy factors (eg. parity, interventions, pregnancy complications). Results: Overall, there was a significant increase in the PPH rate, from 6.1% in 2003 to 8.3% in 2011 (p<0.0001). Having accounted for maternal and pregnancy factors, there was no significant increase in morbidity among women delivering vaginally with a PPH (aOR for yearly change 0.97 (0.94-1.00); p=0.36), and a slight decrease among women delivered by caesarean section (aOR 0.96 (0.92-0.99); p<0.01). There was a slight increase in transfusions for vaginal births (aOR 1.02 (1.00-1.03); p<0.01), however there was no significant trend amongst caesarean births (aOR 0.99 (0.97-1.01); p=0.30). Conclusions: PPH has become more frequent, however this has not been associated with increased maternal morbidity. This suggests that the increase in PPH may represent fewer severe haemorrhages, well-managed haemorrhage or better recording of PPH.