Main Content

Birth haemorrhages increasing in Victoria, researchers find

The rate and severity of postpartum haemorrhage have increased significantly in Victoria, researchers have found.

Researchers Margaret Flood, Susan McDonald, Wendy Pollock, Fiona Cullinane and Mary-Ann Davey used Victorian Perinatal Data Collection statistics to analyse trends in postpartum haemorrhage between 2009 and 2013.

One in five women who gave birth between 2009 and 2013 experienced a primary postpartum haemorrhage (estimated blood loss of 500-749mL) and for one in 71 women, the haemorrhage was severe (blood loss of 1500mL or more).

Postpartum haemorrhage is a leading cause of maternal mortality and morbidity worldwide. The impact of associated morbidities on women and their families can be substantial, researchers said.

Increasing trends in blood transfusion, admission to intensive care or a high dependency unit, and peripartum hysterectomy were also significant, the researchers found.

Women who had an unassisted vaginal birth had the lowest incidence of primary postpartum haemorrhage (11 per cent) and women who had a caesarean section birth had the highest (39 per cent). However, half of all severe postpartum haemorrhages followed unassisted vaginal births.

Severe postpartum haemorrhage was also more common following forceps births, with researchers suggesting this may be due to a de-skilling of the workforce in forceps births.

The research paper Incidence, trends and severity of primary postpartum haemorrhage in Australia: A population-based study using Victorian Perinatal Data Collection data for 764,244 births was published in the Australian and NZ Journal of Obstetrics and Gynaecology 2018.

Other jurisdictions reported postpartum haemorrhage rates of 7.7 per cent (Queensland) up to 25.4 per cent (ACT) and 38 per cent (Northern Territory).

Safer Care Victoria has released clinical guidance for the prevention, assessment and management of postpartum haemorrhage in its Maternity ehandbook.

The researchers questioned whether the postpartum haemorrhage increase since 2009 was due to a change to the World Health Organisation definition resulting in more than 33,490 PPH cases following caesarean births being added to the 2009 data. However, they noted the increase continued beyond 2009, and rates of postpartum haemorrhage also increased for vaginal births.

Reporting a postpartum haemorrhage also changed in 2009 from a tick-box format to reporting by volume of estimated blood loss. Additionally, the definition of postpartum haemorrhage changed to 500 or more mLs regardless of type of birth whereas, up to 2008, this definition had applied only to vaginal births. For caesarean births only blood loss of 750 mL or more met the definition of a postpartum haemorrhage.

This may have contributed to an increase of reported cases, but researchers noted the increasing age of mothers, caesarean rates and obstetric intervention were also possible drivers.