BACKGROUND AND PURPOSE:

• Corbetta-Rastelli et al. (Obstetrics and Gynecology, 2022) analyzed temporal trends in PPH and its associated risk factors

METHODS:

• Repeated cross-sectional study
• Population
  • Delivery hospitalizations from 2000 to 2019 in the National (Nationwide) Inpatient Sample
• Exposures
  • PPH risk factors
• Study design
  • The average annual percent change (AAPC) in PPH was estimated
  • Logistic regression models were performed to determine odds ratios (OR) as a measure of the association between risk factors and outcomes
• Primary outcomes
  • Risk of PPH | PPH requiring blood transfusion | Peripartum hysterectomy in the setting of PPH

RESULTS:

• 76.7 million delivery hospitalizations
  • PPHs: 3.0%
• From 2000 to 2019, the rate of PPH increased
  • 2000: 2.6%
  • 2019: 4.3%
  • AAPC 2.6% (95% CI, 1.7 to 3.5)
  • Over this period, the proportion of deliveries with at least 1 PPH risk factor increased
• 2000: 18.6%
  • 2019: 26.9%
  • AAPC 1.9% (95% CI, 1.7 to 2.0)
• Among deliveries complicated by PPH, blood transfusions increased, followed by a decrease in the most recent decade
  • 2000: 5.4% 2011: 16.7%
  • 2019: 12.6%
• Peripartum hysterectomy among hospitalized individuals with PPH increased, followed by a significant decrease in the final 3 years of the study period
  • 2000: 1.4% 2009: 2.4% 2016: 2.1% 2019: 0.9%
  • AAPC −27.0% (95% CI, −35.2 to −17.6)
• Risk factors associated with PPH and transfusion, and hysterectomy in the setting of PPH were
  • Prior cesarean delivery with previa or placenta accrete
  • Placenta previa without prior cesarean
  • Antepartum hemorrhage or placental abruption
• Individual risk factors associated with the highest odds of PPH included
  • Prior cesarean delivery with previa or placenta accreta spectrum: OR 5.58, 95% CI 5.35 to 5.81)Preeclampsia with severe features: OR 2.90 (95% CI 2.79 to 3.03)Chorioamnionitis or endometritis: OR 2.62 (95% CI 2.54 to 2.70)
  • Placenta previa without prior cesarean delivery: OR 2.39 (95% CI 2.31 to 2.47) 

CONCLUSION:

• PPH and its associated risk factors have increased over the past 20 years
• Despite this increase, the rates of blood transfusions and hysterectomies related to PPH have decreased in recent years
• The authors state

This analysis supports that rising risk may be secondary to an increase in aggregate postpartum hemorrhage risk factors

The proportion of deliveries to individuals with two or more postpartum hemorrhage risk factors increased the most proportionately

Some of the overall risk is due to increasing placenta accreta spectrum, which is a global phenomenon and likely due to increasing cesarean delivery rate 

Learn More – Primary Sources:

Postpartum Hemorrhage Trends and Outcomes in the United States, 2000–2019

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