Trends in postpartum hemorrhage: United States, 1994-2006.
OBJECTIVE
The purpose of this study was to estimate the incidence of postpartum hemorrhage (PPH) in the United States and to assess trends.


METHODS
Population-based data from the 1994-2006 National Inpatient Sample were used to identify women who were hospitalized with postpartum hemorrhage. Data for each year were plotted, and trends were assessed. Multivariable logistic regression was used in an attempt to explain the difference in PPH incidence between 1994 and 2006.


RESULTS
PPH increased 26% between 1994 and 2006 from 2.3% (n = 85,954) to 2.9% (n = 124,708; P < .001). The increase primarily was due to an increase in uterine atony, from 1.6% (n = 58,597) to 2.4% (n = 99,904; P < .001). The increase in PPH could not be explained by changes in rates of cesarean delivery, vaginal birth after cesarean delivery, maternal age, multiple birth, hypertension, or diabetes mellitus.


CONCLUSIONS
Population-based surveillance data signal an apparent increase in PPH caused by uterine atony. More nuanced clinical data are needed to understand the factors that are associated with this trend.
Callaghan
William M
WM
Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA. wcallaghan@cdc.gov
Kuklina
Elena V
EV
Berg
Cynthia J
CJ
D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data; D016208:Databases, Factual; D016640:Diabetes, Gestational / Q000453:epidemiology; D005260:Female; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000453:epidemiology; D015994:Incidence; D016015:Logistic Models; D008423:Maternal Age; D015999:Multivariate Analysis; D010298:Parity; D006473:Postpartum Hemorrhage / Q000453:epidemiology*; D011247:Pregnancy; D014481:United States / Q000453:epidemiology; D014593:Uterine Inertia / Q000453:epidemiology*; D055815:Young Adult