Increasing trends in atonic postpartum haemorrhage in Ireland: an 11-year population-based cohort study.

Abstract

OBJECTIVE:

To derive nationally representative incidence rates of postpartum haemorrhage (PPH), and to investigate trends associated with method of delivery, blood transfusion and morbidly adherent placenta (accreta, percreta and increta).

DESIGN:

Population-based retrospective cohort study.

SETTING:

Republic of Ireland.

POPULATION:

Childbirth hospitalisations during the period 1999-2009.

METHODS:

International Classification of Diseases (ICD)-9-CM and ICD-10-AM diagnostic codes from hospital discharge records were used to identify cases of PPH. Significant temporal trends in PPH incidence were determined using Cochrane-Armitage tests for trend. Log-binomial regression was conducted to assess annual changes in the risk of PPH diagnosis, with adjustment for potential confounding factors.

MAIN OUTCOME MEASURES:

PPH, uterine atony, blood transfusion and morbidly adherent placenta.

RESULTS:

A total of 649,019 childbirth hospitalisations were recorded; 2.6% (n = 16,909) included a diagnosis of PPH. The overall PPH rate increased from 1.5% in 1999 to 4.1% in 2009; atonic PPH rose from 1.0% in 1999 to 3.4% in 2009. Significant increasing trends in atonic PPH rates were observed across vaginal, instrumental, and emergency and elective caesarean deliveries (P < 0.001). The rate of atonic PPH co-diagnosed with blood transfusion also significantly increased (P < 0.001). Relative to 1999, the risk of atonic PPH in 2009 was three-fold increased (adjusted RR 3.03; 95% CI 2.76-3.34). Women diagnosed with a morbidly adherent placenta had a markedly higher risk of total PPH (unadjusted RR 13.14; 95% CI 11.43-15.11).

CONCLUSIONS:

Increasing rates of atonic PPH highlight the pressing need for research and for clinical audit focusing on aetiological factors, preventative measures and quality of care, to guide current clinical practice.

• Authors: J E Lutomski, B M Byrne, D Devane, R A Greene
• Journal: BJOG : an international journal of obstetrics and gynaecology (BJOG) Vol. 119 Issue 3 Pg. 306-14 (Feb 2012) ISSN: 1471-0528 [Electronic] England
• PMID: 22168794 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2011 National Perinatal Epidemiology BJOG An International Journal of Obstetrics and Gynaecology © 2011 RCOG.

Topics

• Adolescent
• Adult
• Blood Transfusion (statistics & numerical data)
• Cohort Studies
• Delivery, Obstetric (statistics & numerical data)
• Female
• Humans
• Incidence
• Ireland (epidemiology)
• Middle Aged
• Multivariate Analysis
• Placenta Accreta (epidemiology)
• Postpartum Hemorrhage (epidemiology, etiology, therapy)
• Pregnancy
• Regression Analysis
• Retrospective Studies
• Risk
• Uterine Inertia (epidemiology)
• Young Adult