PPH occurs in 5% of all live births and is a major contributor to severe maternal morbidity and mortality.[9]American College of Obstetricians and Gynecologists and the Society for Maternal–Fetal Medicine, Kilpatrick SK, Ecker JL. Severe maternal morbidity: screening and review. Am J Obstet Gynecol. 2016 Sep;215(3):B17-22.
http://www.ncbi.nlm.nih.gov/pubmed/27560600?tool=bestpractice.com
[10]Vogel JP, Oladapo OT, Dowswell T, et al. Updated WHO recommendation on intravenous tranexamic acid for the treatment of post-partum haemorrhage. Lancet Glob Health. 2018 Jan;6(1):e18-9.
https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(17)30428-X/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/29100880?tool=bestpractice.com
According to the World Health Organization, of the 14 million women worldwide who experience PPH each year, 70,000 die from the condition, with the majority of deaths occurring in Africa and South Asia.[11]World Health Organization. WHO postpartum haemorrhage (PPH) summit. September 2022 [internet publication].
https://www.who.int/publications/m/item/who-postpartum-haemorrhage-(pph)-summit
[12]International Federation of Gynecology and Obstetrics. Uterine atony and uterotonics in postpartum haemorrhage. October 2023 [internet publication].
https://www.figo.org/resources/figo-statements/uterine-atony-and-uterotonics-postpartum-haemorrhage
In the UK and Ireland, the Confidential Enquiry into Maternal Deaths and Morbidity reported that 17 women died from obstetric haemorrhage during or up to 6 weeks after the end of pregnancy in the period 2019-2021, giving an overall mortality rate of 0.80 per 100,000 maternities (95% CI 0.48 to 1.27).[13]MBRRACE-UK. Saving lives, improving mothers’ care. Lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2019-21. 2023 [internet publication].
https://www.npeu.ox.ac.uk/mbrrace-uk/reports
In the US, mortality from PPH accounted for just over 10% of maternal deaths in 2009 (approximately 1.7 deaths per 100,000 live births).[3]Committee on Practice Bulletins-Obstetrics. Practice bulletin no. 183: postpartum hemorrhage. Obstet Gynecol. 2017 Oct;130(4):e168-86.
http://www.ncbi.nlm.nih.gov/pubmed/28937571?tool=bestpractice.com
Global rates of PPH have been on the rise since the early 2000s.[14]Mehrabadi A, Hutcheon JA, Lee L, et al. Trends in postpartum hemorrhage from 2000 to 2009: a population-based study. BMC Pregnancy Childbirth. 2012 Oct 11;12:108.
https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/1471-2393-12-108
http://www.ncbi.nlm.nih.gov/pubmed/23057683?tool=bestpractice.com
[15]Mehrabadi A, Liu S, Bartholomew S, et al. Temporal trends in postpartum hemorrhage and severe postpartum hemorrhage in Canada from 2003 to 2010. J Obstet Gynaecol Can. 2014 Jan;36(1):21-33.
https://www.jogc.com/article/S1701-2163(15)30680-0/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/24444284?tool=bestpractice.com
[16]Lutomski JE, Byrne BM, Devane D, et al. Increasing trends in atonic postpartum haemorrhage in Ireland: an 11-year population-based cohort study. BJOG. 2012 Feb;119(3):306-14.
http://www.ncbi.nlm.nih.gov/pubmed/22168794?tool=bestpractice.com
In the US alone, PPH rates increased by 13% between 2010 and 2014.[17]Reale SC, Easter SR, Xu X, et al. Trends in postpartum hemorrhage in the United States from 2010 to 2014. Anesth Analg. 2020 May;130(5):e119-22.
https://journals.lww.com/anesthesia-analgesia/fulltext/2020/05000/trends_in_postpartum_hemorrhage_in_the_united.26.aspx
http://www.ncbi.nlm.nih.gov/pubmed/31567319?tool=bestpractice.com
Nonetheless, mortality in the US has declined since the late 1980s, believed to be attributable to improved management with increasing rates of transfusion and peripartum hysterectomy.[3]Committee on Practice Bulletins-Obstetrics. Practice bulletin no. 183: postpartum hemorrhage. Obstet Gynecol. 2017 Oct;130(4):e168-86.
http://www.ncbi.nlm.nih.gov/pubmed/28937571?tool=bestpractice.com
Maternal mortality disproportionately affects individuals of lower socioeconomic status and those residing in low-resource countries. A 2014 systematic analysis of maternal deaths found that PPH is responsible for 8% of maternal deaths in developed countries and 20% of maternal deaths in developing regions.[18]Say L, Chou D, Gemmill A, et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health. 2014 Jun;2(6):e323-33.
https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(14)70227-X/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/25103301?tool=bestpractice.com
This disparity suggests that a substantial proportion of these deaths could be prevented with improved resources.[18]Say L, Chou D, Gemmill A, et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health. 2014 Jun;2(6):e323-33.
https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(14)70227-X/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/25103301?tool=bestpractice.com
[19]Nathan LM. An overview of obstetric hemorrhage. Semin Perinatol. 2019 Feb;43(1):2-4.
http://www.ncbi.nlm.nih.gov/pubmed/30691692?tool=bestpractice.com