How Has the Incidence of Postpartum Hemorrhage Changed Over the Past 20 Years in the US?
BACKGROUND AND PURPOSE:
Corbetta-Rastelli et al. (Obstetrics and Gynecology, 2022) analyzed temporal trends in PPH and its associated risk factors
Repeated cross-sectional study
Delivery hospitalizations from 2000 to 2019 in the National (Nationwide) Inpatient Sample
PPH risk factors
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
Risk of PPH | PPH requiring blood transfusion | Peripartum hysterectomy in the setting of PPH
76.7 million delivery hospitalizations
From 2000 to 2019, the rate of PPH increased
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
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%
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)
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
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