Post-partum haemorrhage (PPH) immediately after giving birth is the largest threat to new mothers in high-income countries. An Australian study shows that an increasing number of women suffered severe problems arising from blood loss after delivery.
Christine Roberts from the University of Sydney and Royal North Shore Hospital led a team of researchers who studied the birth-hospital discharge records of the 500,603 women who had children in New South Wales during the study period. She said, "We identified 6242 women who suffered severe adverse outcomes, including 22 who died in hospital. Of the 6242, 67% had an obstetric haemorrhage (60% PPH)".
The consequences of adverse maternal outcomes can include infertility, psychological effects, disability and even death. According to Roberts, "Active management of the third stage of labour, delivery of the placenta, is effective in reducing PPH. Unfortunately, adherence to active third-stage management recommendations is poorly reported and/or suboptimal in Australia, and significant variations in policies and practice have been reported in Europe. Suboptimal adherence to active management guidelines could explain the rising PPH rates".
The authors found that between 1999 and 2004 the annual rate of adverse maternal outcomes increased by 20.9%. This increase occurred almost entirely among women who had a PPH. Although adverse outcomes also increased among women with conditions related to high blood pressure, over half these women also had a PPH. Roberts said, "Women with risk factors for PPH, such as a very low placenta or a previous PPH, should give birth in hospitals with facilities to manage severe haemorrhage."
The authors conclude, "We feel that all women should have access to active management of the third stage of labour and careful observation in the first two hours after delivery, as this may reduce the PPH rate and the potential for severe harm and death".
- Christine L Roberts, Jane B Ford, Charles S Algert, Jane C Bell, Judy M Simpson and Jonathan M Morris. Trends in adverse maternal outcomes during childbirth: a population-based study of severe maternal morbidity. BMC Pregnancy and Childbirth, (in press)
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