Temporal trends in postpartum hemorrhage and severe postpartum hemorrhage in Canada from 2003 to 2010.
OBJECTIVE
Increases in postpartum hemorrhage have been reported from several countries. We assessed temporal trends in postpartum hemorrhage and severe postpartum hemorrhage in Canada between 2003 and 2010.


METHODS
We carried out a population-based cohort study of all hospital deliveries in Canada (excluding Quebec) from 2003 to 2010 (n = 2 193 425), using data from the Canadian Institute for Health Information. Postpartum hemorrhage was defined as a blood loss of ≥ 500 mL following vaginal delivery or ≥ 1000 mL following Caesarean section, or as noted by the care provider. Severe postpartum hemorrhage was defined as postpartum hemorrhage plus blood transfusion, hysterectomy, or other procedures to control bleeding (including uterine suturing or ligation/embolization of pelvic arteries). Temporal trends were assessed using the chi-square test for trend, relative risks, and logistic regression.


RESULTS
Postpartum hemorrhage increased by 22% (95% CI 20% to 25%) from 5.1% in 2003 to 6.2% in 2010 (P < 0.001), driven by a 29% increase (95% CI 26% to 33%) in atonic postpartum hemorrhage (3.9% in 2003 vs. 5.0% in 2010, P < 0.001). Postpartum hemorrhage with blood transfusion increased from 36.7 to 50.4 per 10 000 deliveries (P < 0.001), while postpartum hemorrhage with hysterectomy increased from 4.9 to 5.8 per 10 000 deliveries (P < 0.01). Postpartum hemorrhage with uterine suturing, or ligation/embolization of pelvic arteries, increased from 4.1 to 10.7 per 10 000 deliveries (P < 0.001). These increases occurred in most provinces and territories, and could not be explained by changes in maternal, fetal, and obstetric factors.


CONCLUSIONS
Rates of postpartum hemorrhage and severe postpartum hemorrhage continued to increase in Canada between 2003 and 2010.
Department of Obstetrics and Gynaecology, and the School of Population and Public Health, University of British Columbia, and the Children's and Women's Hospital and Health Centre of British Columbia, Vancouver BC.
Azar
A
Mehrabadi
Maternal and Infant Health Section, Public Health Agency of Canada, Ottawa ON.
Shiliang
S
Liu
Maternal and Infant Health Section, Public Health Agency of Canada, Ottawa ON.
Sharon
S
Bartholomew
Department of Obstetrics and Gynaecology, and the School of Population and Public Health, University of British Columbia, and the Children's and Women's Hospital and Health Centre of British Columbia, Vancouver BC.
Jennifer A
JA
Hutcheon
Departments of Pediatrics, and of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal QC.
Michael S
MS
Kramer
Department of Obstetrics and Gynaecology, University of British Columbia, and the Children's and Women's Hospital and Health Centre of British Columbia, Vancouver BC.
Robert M
RM
Liston
Department of Obstetrics and Gynaecology, and the School of Population and Public Health, University of British Columbia, and the Children's and Women's Hospital and Health Centre of British Columbia, Vancouver BC.
K S
KS
Joseph
D000328:Adult; D001803:Blood Transfusion; D002170:Canada / Q000453:epidemiology; D002585:Cesarean Section; D036861:Delivery, Obstetric; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D007044:Hysterectomy; D006473:Postpartum Hemorrhage / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D011247:Pregnancy; D012307:Risk Factors; D014593:Uterine Inertia; D055815:Young Adult
atonic postpartum hemorrhage; maternal morbidity; postpartum hemorrhage; uterine atony