Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2015

Open Access 01-12-2015 | Research article

Regional differences in severe postpartum hemorrhage: a nationwide comparative study of 1.6 million deliveries

Authors: Babette W Prick, Joost F von Schmidt auf Altenstadt, Chantal WPM Hukkelhoven, Gouke J Bonsel, Eric AP Steegers, Ben W Mol, Joke M Schutte, Kitty WM Bloemenkamp, Johannes J Duvekot

Published in: BMC Pregnancy and Childbirth | Issue 1/2015

Login to get access

Abstract

Background

The incidence of severe postpartum hemorrhage (PPH) is increasing. Regional variation may be attributed to variation in provision of care, and as such contribute to this increasing incidence. We assessed reasons for regional variation in severe PPH in the Netherlands.

Methods

We used the Netherlands Perinatal Registry and the Dutch Maternal Mortality Committee to study severe PPH incidences (defined as blood loss ≥ 1000 mL) across both regions and neighborhoods of cities among all deliveries between 2000 and 2008. We first calculated crude incidences. We then used logistic multilevel regression analyses, with hospital or midwife practice as second level to explore further reasons for the regional variation.

Results

We analyzed 1599867 deliveries in which the incidence of severe PPH was 4.5%. Crude incidences of severe PPH varied with factor three between regions while between neighborhoods variation was even larger. We could not explain regional variation by maternal characteristics (age, parity, ethnicity, socioeconomic status), pregnancy characteristics (singleton, gestational age, birth weight, pre-eclampsia, perinatal death), medical interventions (induction of labor, mode of delivery, perineal laceration, placental removal) and health care setting.

Conclusions

In a nationwide study in The Netherlands, we observed wide practice variation in PPH. This variation could not be explained by maternal characteristics, pregnancy characteristics, medical interventions or health care setting. Regional variation is either unavoidable or subsequent to regional variation of a yet unregistered variable.
Appendix
Available only for authorised users
Literature
1.
World Health Organisation. Maternal mortality in 2000; estimates developed by WHO, UNICEF, and UNFPA. Geneva: World Health Organisation; 2004.
2.
AbouZahr C. Global burden of maternal death and disability. Br Med Bull. 2003;67:1–11.PubMed
3.
Oyelese Y, Ananth CV. Postpartum hemorrhage: epidemiology, risk factors, and causes. Clin Obstet Gynecol. 2010;53(1):147–56.PubMed
4.
Khan KS, Wojdyla D, Say L, Gulmezoglu AM, Van Look PF. WHO analysis of causes of maternal death: a systematic review. Lancet. 2006;367(9516):1066–74.PubMed
5.
Carroli G, Cuesta C, Abalos E, Gulmezoglu AM. Epidemiology of postpartum haemorrhage: a systematic review. Best Pract Res Clin Obstet Gynaecol. 2008;22(6):999–1012.PubMed
6.
Bateman BT, Berman MF, Riley LE, Leffert LR. The epidemiology of postpartum hemorrhage in a large, nationwide sample of deliveries. Anesth Analg. 2010;110(5):1368–73.PubMed
7.
Callaghan WM, Kuklina EV, Berg CJ. Trends in postpartum hemorrhage: United States, 1994–2006. Am J Obstet Gynecol. 2010;202(4):353. e351-356.PubMed
8.
Knight M, Callaghan WM, Berg C, Alexander S, Bouvier-Colle MH, Ford JB, et al. Trends in postpartum hemorrhage in high resource countries: a review and recommendations from the International Postpartum Hemorrhage Collaborative Group. BMC Pregnancy Childbirth. 2009;9:55.PubMedPubMedCentral
9.
Joseph KS, Rouleau J, Kramer MS, Young DC, Liston RM, Baskett TF. Investigation of an increase in postpartum haemorrhage in Canada. BJOG. 2007;114(6):751–9.PubMed
10.
Cameron CA, Roberts CL, Olive EC, Ford JB, Fischer WE. Trends in postpartum haemorrhage. Aust N Z J Public Health. 2006;30(2):151–6.PubMed
11.
Ford JB, Roberts CL, Simpson JM, Vaughan J, Cameron CA. Increased postpartum hemorrhage rates in Australia. Int J Gynaecol Obstet. 2007;98(3):237–43.PubMed
12.
Rossen J, Okland I, Nilsen OB, Eggebo TM. Is there an increase of postpartum hemorrhage, and is severe hemorrhage associated with more frequent use of obstetric interventions? Acta Obstet Gynecol Scand. 2010;89(10):1248–55.PubMed
13.
Lutomski JE, Byrne BM, Devane D, Greene RA. Increasing trends in atonic postpartum haemorrhage in Ireland: an 11-year population-based cohort study. BJOG. 2012;119(3):306–14.PubMed
14.
World Health Organisation. WHO guidelines for the management of postpartum haemorrhage and retained placenta. Geneva: World Health Organisation; 2009.
15.
Fong A, Leake J, Pan D, Ogunyemi D. Demographic, institutional and obstetrical risk factors for postpartum haemorrhage mortality. J Obstet Gynaecol. 2010;30(5):470–5.PubMed
16.
Schutte JM, Steegers EA, Schuitemaker NW, Santema JG, de Boer K, Pel M, et al. Rise in maternal mortality in the Netherlands. BJOG. 2010;117(4):399–406.PubMed
17.
Registry TNP. Perinatal care in The Netherlands 2006 (in Dutch: Perinatalezorg in Nederland 2006). Utrecht: The Netherlands Perinatal Registry; 2008.
18.
van der Kooy J, Poeran J, de Graaf JP, Birnie E, Denktass S, Steegers EA, et al. Planned home compared with planned hospital births in the Netherlands: intrapartum and early neonatal death in low-risk pregnancies. Obstet Gynecol. 2011;118(5):1037–46.PubMed
19.
De Graaf J, Schutte J, Poeran J, van Roosmalen J, Bonsel G, Steegers E. Regional differences in Dutch maternal mortality. BJOG. 2012;119(5):582–8.PubMed
20.
de Graaf JP, Ravelli AC, de Haan MA, Steegers EA, Bonsel GJ. Living in deprived urban districts increases perinatal health inequalities. J Matern Fetal Neonatal Med. 2013;26(5):473–81.PubMed
21.
de Graaf JP, Steegers EA, Bonsel GJ. Inequalities in perinatal and maternal health. Curr Opin Obstet Gynecol. 2013;25(2):98–108.PubMed
22.
Al-Zirqi I, Vangen S, Forsen L, Stray-Pedersen B. Effects of onset of labor and mode of delivery on severe postpartum hemorrhage. Am J Obstet Gynecol. 2009;201(3):273. e271-279.PubMed
23.
24.
Brown MA, Lindheimer MD, de Swiet M, Van Assche A, Moutquin JM. The classification and diagnosis of the hypertensive disorders of pregnancy: statement from the International Society for the Study of Hypertension in Pregnancy (ISSHP). Hypertens Pregnancy. 2001;20(1):IX–XIV.PubMed
25.
Visser GH, Eilers PH, Elferink-Stinkens PM, Merkus HM, Wit JM. New Dutch reference curves for birthweight by gestational age. Early Hum Dev. 2009;85(12):737–44.PubMed
26.
Prick BW, Vos AA, Hop WC, Bremer HA, Steegers EA, Duvekot JJ. The current state of active third stage management to prevent postpartum hemorrhage: a cross-sectional study. Acta Obstet Gynecol Scand. 2013;92(11):1277–83.PubMed
27.
Grol R, Grimshaw J. From best evidence to best practice: effective implementation of change in patients’ care. Lancet. 2003;362(9391):1225–30.PubMed
28.
Lu MC, Fridman M, Korst LM, Gregory KD, Reyes C, Hobel CJ, et al. Variations in the incidence of postpartum hemorrhage across hospitals in California. Matern Child Health J. 2005;9(3):297–306.PubMed
29.
Al-Zirqi I, Vangen S, Forsen L, Stray-Pedersen B. Prevalence and risk factors of severe obstetric haemorrhage. BJOG. 2008;115(10):1265–72.PubMed
30.
Bais JM, Eskes M, Pel M, Bonsel GJ, Bleker OP. Postpartum haemorrhage in nulliparous women: incidence and risk factors in low and high risk women. A Dutch population-based cohort study on standard (> or = 500 ml) and severe (> or = 1000 ml) postpartum haemorrhage. Eur J Obstet Gynecol Reprod Biol. 2004;115(2):166–72.PubMed
31.
Combs CA, Murphy EL, Laros Jr RK. Factors associated with postpartum hemorrhage with vaginal birth. Obstet Gynecol. 1991;77(1):69–76.PubMed
32.
Biguzzi E, Franchi F, Ambrogi F, Ibrahim B, Bucciarelli P, Acaia B, et al. Risk factors for postpartum hemorrhage in a cohort of 6011 Italian women. Thromb Res. 2012;129(4):e1–7.PubMed
33.
Combs CA, Murphy EL, Laros Jr RK. Factors associated with hemorrhage in cesarean deliveries. Obstet Gynecol. 1991;77(1):77–82.PubMed
34.
Heres MH, Pel M, Elferink-Stinkens PM, Van Hemel OJ, Treffers PE. The Dutch obstetric intervention study–variations in practice patterns. Int J Gynaecol Obstet. 1995;50(2):145–50.PubMed
35.
Davis D, Baddock S, Pairman S, Hunter M, Benn C, Anderson J, et al. Risk of severe postpartum hemorrhage in low-risk childbearing women in New Zealand: exploring the effect of place of birth and comparing third stage management of labor. Birth. 2012;39:98–105.PubMed
36.
de Jonge A, Mesman JA, Mannien J, Zwart JJ, van Dillen J, van Roosmalen J. Severe adverse maternal outcomes among low risk women with planned home versus hospital births in the Netherlands: nationwide cohort study. BMJ. 2013;346:f3263.PubMedPubMedCentral
37.
Burrows LJ, Meyn LA, Weber AM. Maternal morbidity associated with vaginal versus cesarean delivery. Obstet Gynecol. 2004;103(5 Pt 1):907–12.PubMed
38.
Stafford I, Dildy GA, Clark SL, Belfort MA. Visually estimated and calculated blood loss in vaginal and cesarean delivery. Am J Obstet Gynecol. 2008;199(5):519. e511-517.PubMed
39.
Haeri S, Dildy 3rd GA. Maternal mortality from hemorrhage. Semin Perinatol. 2012;36(1):48–55.PubMed
40.
Blomberg M. Maternal obesity and risk of postpartum hemorrhage. Obstet Gynecol. 2011;118(3):561–8.PubMed
41.
Paglia MJ, Grotegut CA, Johnson LN, Thames B, James AH. Body mass index and severe postpartum hemorrhage. Gynecol Obstet Invest. 2012;73(1):70–4.PubMed
42.
Zwart JJ, Dijk PD, van Roosmalen J. Peripartum hysterectomy and arterial embolization for major obstetric hemorrhage: a 2-year nationwide cohort study in the Netherlands. Am J Obstet Gynecol. 2010;202(2):150. e151-157.PubMed
43.
44.
Bose P, Regan F, Paterson-Brown S. Improving the accuracy of estimated blood loss at obstetric haemorrhage using clinical reconstructions. BJOG. 2006;113(8):919–24.PubMed
45.
Dildy 3rd GA, Paine AR, George NC, Velasco C. Estimating blood loss: can teaching significantly improve visual estimation? Obstet Gynecol. 2004;104(3):601–6.PubMed
46.
Duthie SJ, Ven D, Yung GLK, Guang DZ, Chan SYW, Ma HK. Discrepancy between laboratory determination and visual estimation of blood loss during normal delivery. Eur J Obstet Gynecol Reprod Biol. 1990;38:119–24.
Metadata
Title
Regional differences in severe postpartum hemorrhage: a nationwide comparative study of 1.6 million deliveries
Authors
Babette W Prick
Joost F von Schmidt auf Altenstadt
Chantal WPM Hukkelhoven
Gouke J Bonsel
Eric AP Steegers
Ben W Mol
Joke M Schutte
Kitty WM Bloemenkamp
Johannes J Duvekot
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2015
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-015-0473-8

Other articles of this Issue 1/2015

BMC Pregnancy and Childbirth 1/2015 Go to the issue

Study protocol

Prevention of bacterial infections in the newborn by pre-delivery administration of azithromycin: Study protocol of a randomized efficacy trial

Research article

How UK internet websites portray breast milk expression and breast pumps: a qualitative study of content

Research article

Postnatal depressive symptoms amongst women in Central Vietnam: a cross-sectional study investigating prevalence and associations with social, cultural and infant factors

Research article

Barriers to antenatal care use in Nigeria: evidences from non-users and implications for maternal health programming

Research article

“We have been working overnight without sleeping”: traditional birth attendants’ practices and perceptions of post-partum care services in rural Tanzania

Research article

Correlates of male involvement in maternal and newborn health: a cross-sectional study of men in a peri-urban region of Myanmar