Bleeding after birth is becoming more common
Definition, rates, and what is given.
Postpartum hemorrhage is now defined as cumulative blood loss of 1,000 mL or more, or blood loss with signs of low blood volume, within 24 hours of birth, regardless of how the baby was delivered.
Across 76.7 million US delivery hospitalizations, the rate rose from 2.7% in 2000 to 4.3% in 2019. The proportion of deliveries with at least one risk factor rose from 18.6% to 26.9%. Transfusion among hemorrhage cases rose then fell; hysterectomy rose to 2.4% in 2009 then fell to 0.9% by 2019.
For prevention, across 196 trials and 135,559 women, compared with oxytocin alone, ergometrine plus oxytocin (relative risk 0.70), carbetocin (relative risk 0.72) and misoprostol plus oxytocin (relative risk 0.70) all reduced bleeding over 500 mL. The combinations cause more vomiting and fever.
For treatment, the WOMAN trial randomized 20,060 women with established hemorrhage to tranexamic acid or placebo. Death from bleeding was 1.5% against 1.9% (relative risk 0.81). Given within 3 hours of birth the effect was larger, 1.2% against 1.7%. Hysterectomy was not reduced at all, and the combined outcome of death or hysterectomy was not significantly different.