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Trends in Postpartum Hemorrhage in the United States from 2010-2014
Abstract Number: F4A-1
Abstract Type: Original Research
Postpartum hemorrhage (PPH) is an important source of maternal morbidity and mortality in the US.1 Studies from the 1990s-2000s showed an increasing prevalence of PPH, with uterine atony as the leading cause.2,3 This led to state and national quality improvement initiatives aimed at reducing the morbidity associated with PPH.4 The purpose of this study was to define trends in the prevalence of PPH and related morbidity using the most recent data available.
The data source was the National Inpatient Sample, a survey sample designed to be representative of all inpatient admissions in the US. It is maintained by the Agency for Healthcare Research and Quality. A validated algorithm was used to identify hospital admissions for delivery and PPH was identified using appropriate diagnostic codes.3,5 Temporal trends in PPH were assessed, as was the risk of associated complications. Logistic regression accounted for the survey design and trend weights, and was used to assess whether trends could be explained by changes in risk factors over time.
From 2010 to 2014, the prevalence of PPH increased from 2.9% to 3.2% of deliveries (p-value for trend=0.002). Uterine atony was the leading etiology of PPH, accounting for 79.0% of all cases. The prevalence of PPH from uterine atony increased from 2.2% to 2.6% (p=0.0003). The frequency of PPH from retained placenta and coagulopathy remained stable.
After adjusting for risk factors for PPH, including patient demographics, comorbidities, obstetric conditions, and hospital characteristics, year of delivery was no longer associated with the risk of PPH (adjusted odds ratio per year increase, 1.01 (95% CI 0.99-1.03)).
PPH was significantly associated with all measures of severe maternal morbidity assessed, including sepsis, acute renal failure, coagulopathy, hysterectomy, blood transfusion, acute respiratory failure, mechanical ventilation, venous thromboembolism, pulmonary embolism, cardiac arrest, and death. Among patients with PPH, there was a significant decline in the risk of coagulopathy (p=0.0059) and acute respiratory failure (p<0.0001), but an increase in the risk of sepsis (p=0.0002) and acute renal failure (p=0.0007). Other measures did not significantly change.
The risk of PPH increased from 2010 to 2014, but this was explained by the rising prevalence of risk factors for PPH. The frequency of severe maternal morbidity for women with PPH was stable for most outcomes assessed. This suggests that efforts aimed at improving PPH prevention and treatment may have resulted in stabilization in the prevalence of PPH, which had increased rapidly over the prior decade.
1. Creanga Obstet Gynecol 2015
2. Knight BMC Pregnancy Childbirth 2009
3. Bateman A&A 2010
4. Main Obstet Gynecol 2015
5. Kuklina Matern Child Health J 2008