Authors (including presenting author) :
Kong CW(1), To WWK(1), Leung WC(2), on behalf of PPH Concern Group
Affiliation :
(1) Department of Obstetrics & Gynaecology, United Christian Hospital (2) Department of Obstetrics & Gynaecology, Kwong Wah Hospital
Introduction :
Postpartum haemorrhage (PPH) accounts for up to 35% of all maternal mortalities worldwide. A progressively increasing incidence of PPH has been reported in many developed countries in recent decades, including Hong Kong. This rising trend in PPH has been ascribed to various risk factors, such as increase in maternal age, and increasing rates of induction of labour and caesarean sections.
Objectives :
To investigate the incidence, risk factors, causes of PPH and the effectiveness of various PPH treatment in all public obstetric units under Hospital Authority (KWH, PYNEH, PWH, PMH, QEH, QMH, TMH, UCH).
Methodology :
A retrospective cohort of all women with PPH (blood loss >=500 ml) between 2014 to 2023 were identified and retrieved from the Clinical Data Analysis and Reporting System (CDARS). Risk factors and clinical details of the deliveries such as maternal age, parity, mode of delivery, amount of blood loss, cause of PPH, second-line procedures employed, and maternal and fetal outcomes were retrieved. Univariate analyses and logistic regression analyses were employed to delineate the maternal and intrapartum risk factors associated with PPH.
Result & Outcome :
Among a total of 314,389 maternities from 2014 to 2023, the overall PPH rate was 12.6%, increasing from 10% in 2014 to 14.7% in 2023. The increase was mostly contributed by the increase in minor PPH (between 500–1000 ml), from 8.67% in 2014 to 11.8% in 2023, while major PPH (blood loss>1000 ml) and severe PPH (blood loss>1500 ml) increased from 1.28% to 2.90% and 0.51% to 1.01% respectively. Significant increases in PPH rates were seen due to uterine atony (6.04% in 2014; 7.87% in 2020) and genital trauma (2.91% in 2014; 7.11% in 2022), while that from placental causes remained around 1%. Logistic regression analysis found caesarean section (rate 24.1% in 2014; 31.2% in 2023)(odds ratio (OR) 5.45), antepartum hemorrhage (OR 2.04) and multiple pregnancy (OR 2.0) were the three most significant risk factors associated with PPH. Although the incidence of PPH has increased, with the increase in use of second-line procedures (3.06 per 1000 maternities in 2014 to 8.11 in 2023), peripartum hysterectomy rates remain constant (0.05-0.06% of all maternities) throughout the study period. Conclusion: PPH is increasing in all the units and caesarean section is the most significant risk factor for PPH.
