The Growing Danger of Postpartum Hemorrhage

Postpartum hemorrhage (PPH) immediately after giving birth is the largest threat to new mothers in high-income countries, according to a new study.

Researchers from the University of Sydney (NSW, Australia) and Royal North Shore Hospital (RNSH; Sydney, NSW, Australia) conducted a population-based study of severe maternal morbidity by studying the birth-hospital discharge records of 500,603 women who had children in New South Wales (Australia) between 1999 and 2004. The researchers identified 6,242 women who suffered severe adverse outcomes, including 22 who died in hospital. Of these 6,242 women, 67% had an obstetric hemorrhage, of which 60% had PPH. The researchers found that the annual rate of adverse maternal outcomes increased over the study period by 20.9%; this increase occurred almost entirely among women who had a PPH. And although adverse outcomes also increased among women with conditions related to high blood pressure, over half these women also had a PPH. The researchers therefore recommended that all women should have access to active management of the third stage of labor and careful observation in the first two hours after delivery, as this may reduce the PPH rate and the potential for severe harm and death. The study was published on February 26, 2009, in the open access journal BMC Pregnancy and Childbirth, a publication of BioMed Central.

"Active management of the third stage of labor, delivery of the placenta, is effective in reducing PPH. Unfortunately, adherence to active third-stage management recommendations is poorly reported and/or suboptimal in Australia, and significant variations in policies and practice have been reported in Europe,” said lead author Christine Roberts, M.D., of the department of obstetrics and gynecology. "Suboptimal adherence to active management guidelines could explain the rising PPH rates.”

Postpartum hemorrhage is defined as the loss of more than 500 ml of blood following vaginal delivery, and is the most common cause of death of the delivering mother within the developed world. Causes of postpartum hemorrhage are generally broken down into four categories, commonly called "The Four T's”: Trauma from the delivery may tear tissue and vessels leading to significant postpartum bleeding; uterine atony (Tone) refers to the inability of the uterus to contract and may lead to continuous bleeding; retained placental tissue and infection may contribute to uterine atony; Tissue refers to any cellular debris from the placenta or fetus that may be left in the uterus, causing the uterus to not contract; Thrombin refers to some failure of clotting, such as with diseases known as coagulopathies.

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University of Sydney
Royal North Shore Hospital