Trends in postpartum haemorrhage

Objective: To assess trends and outcomes of postpartum haemorrhage (PPH) in New South Wales (NSW). Methods: A population‐based descriptive study of all 52,151 women who had a PPH either during the hospital stay for the birth of their baby or requiring a re‐admission to hospital between 1994 and 2002. Data were obtained from the de‐identified computerised census of NSW hospital in‐patients and analysed to examine trends over time. The outcome measures included maternal death, hysterectomy, admission to intensive care unit (ICU), transfusion and major maternal morbidity, including procedures to reduce blood supply to the uterus, acute renal failure and postpartum coaqulation defects. Results: From 1994 to 2002 both the number and adjusted (for under‐reporting) rate of PPH during the birth admission increased from 8.3% of deliveries to 10.7%. The rate of PPH adjusted for maternal age and mode of delivery was similar to the unadjusted rate. There was a sixfold increase in the rate of transfusions from 1.9% of women who haemorrhaged to 11.7%. Hospital readmissions for PPH declined from 1.2% of deliveries to 0.9%. These were statistically significant changes. There were no significant changes in the rate of hysterectomies, procedures to reduce blood supply to the uterus, admissions to ICU, acute renal failure or coagulation defects. Conclusion: The increased rate of PPH during the birth admission is concerning. The increase in PPH could not be explained by increasing maternal age or caesarean sections. Linked birth and hospital discharge data could determine whether the increase in PPH is caused by other changes in obstetric practices or population.