Postpartum hemorrhage with transfusion: Trends, near misses, risk factors and management at the scale of a perinatal network

Objectives. - To analyze temporal trends and management of postpartum hemorrhage (PPH) with transfusion and its related maternal near-miss (MNM) cases between 2006 and 2014 and to study risk factors. Material and methods. - This retrospective cohort study from two prospective databases included 156,047 women giving birth in all the maternity hospitals of Burgundy. We analyzed temporal trends and the distribution of PPH with transfusion, the circumstances of transfer of patients between hospitals and factors associated with PPH with transfusion. PPH with massive blood transfusion and/or nonmedical treatment was defined as MNM. Statistical analysis included Chit tests and logistic regression for multivariate analysis. Results. - The overall rate of PPH with transfusion was 7.3%o and globally increased during the study period whereas the MNM rate did not. MNM represented 37% of patients with PPH with transfusion and 71% of transferred patients, but surgical treatments were performed before transfer. Factors associated with PPH with transfusion were maternal age > 35 years (odds ratio [OR] =1.3), prematurity (OR = 5.0), cesarean section (OR = 4.8), placenta previa (OR = 22.0), twin pregnancy (OR = 6.6), HELLP syndrome (OR = 17.9) and severe small-for-gestational-age infants (O R= 2.0). The first four were also associated with MNM. Conclusion. - MNM cases of PPH rates were steady in Burgundy while rates of PPH with transfusion increased moderately. (C) 2017 Elsevier Masson SAS. All rights reserved.