title: Postpartum haemorrhage management, risks, and maternal outcomes: findings from the World Health Organization Multicountry Survey on Maternal and Newborn Health.
abstract: OBJECTIVE
  To explore the clinical practices, risks, and maternal outcomes associated with postpartum haemorrhage (PPH).
  
  
  METHODS
  Secondary analysis of cross-sectional data.
  
  
  METHODS
  A total of 352 health facilities in 28 countries.
  
  
  METHODS
  A total of 274 985 women giving birth between 1 May 2010 and 31 December 2011.
  
  
  METHODS
  We used multivariate logistic regression to examine factors associated with PPH among all births, and the Pearson chi-square test to examine correlates of severe maternal outcomes (SMOs) among women with PPH. All analyses adjust for facility- and country-level clustering.
  
  
  METHODS
  PPH, SMOs, and clinical practices for the management of PPH.
  
  
  RESULTS
  Of all the women included in the analysis, 95.3% received uterotonic prophylaxis and the reported rate of PPH was 1.2%. Factors significantly associated with PPH diagnosis included age, parity, gestational age, induction of labour, caesarean section, and geographic region. Among those with PPH, 92.7% received uterotonics for treatment, and 17.2% had an SMO. There were significant differences in the incidence of SMOs by age, parity, gestational age, anaemia, education, receipt of uterotonics for prophylaxis or treatment, referral from another facility, and Human Development Index (HDI) group. The rates of death were highest in countries with low or medium HDIs.
  
  
  CONCLUSIONS
  Among women with PPH, disparities in the incidence of severe maternal outcomes persist, even among facilities that report capacity to provide all essential emergency obstetric interventions. This highlights the need for better information about the role of institutional capacity, including quality of care, in PPH-related morbidity and mortality.
authors.affiliation: Gynuity Health Projects, New York, NY, USA.
authors.forename: W R
authors.initials: WR
authors.lastname: Sheldon
authors.forename: J
authors.initials: J
authors.lastname: Blum
authors.forename: J P
authors.initials: JP
authors.lastname: Vogel
authors.forename: J P
authors.initials: JP
authors.lastname: Souza
authors.forename: A M
authors.initials: AM
authors.lastname: Gülmezoglu
authors.forename: B
authors.initials: B
authors.lastname: Winikoff
mesh_terms: D000293:Adolescent; D000328:Adult; D002585:Cesarean Section / Q000401:mortality; D003430:Cross-Sectional Studies; D005260:Female; D005865:Gestational Age; D014943:Global Health; D006801:Humans; D007231:Infant, Newborn; D007749:Labor Stage, Third / Q000187:drug effects*; D007743:Labor, Obstetric; D008428:Maternal Mortality; D008430:Maternal-Child Health Centers / Q000592:standards*; D010120:Oxytocics / Q000627:therapeutic use*; D010121:Oxytocin / Q000627:therapeutic use*; D010298:Parity; D006473:Postpartum Hemorrhage / Q000401:mortality / Q000517:prevention & control*; D011247:Pregnancy; D011787:Quality of Health Care; D012307:Risk Factors; D012424:Rural Population; D013997:Time Factors; D014505:Urban Population
chemical_list: D010120:Oxytocics; D010121:Oxytocin
keywords: Maternal death; maternal near miss; postpartum haemorrhage; quality of care; uterotonics