Trends in postpartum hemorrhage among delivery hospitalizations in New York City 2008-2012

Background: Hemorrhage is one of the leading causes of pregnancy-associated mortality and morbidity; with medical management, it is also considered one of the most preventable causes. National estimates for postpartum hemorrhage (PPH) and its managing procedures, such as transfusion and hysterectomy, show that rates are increasing. Study objectives were to examine these trends in New York City (NYC).

Methods: We identified delivery hospitalizations in NYC from 2008-2012 hospital discharge data. Cases of PPH due to uterine atony (666.1x) and other causes (666.0x, 666.2x, 666.3x) were identified by ICD-9-CM diagnosis codes. Transfusion of whole blood or packed cells and hysterectomy were identified by ICD-9-CM procedure codes (99.03, 99.04 and 68.3–68.9, respectively). We used the Cochran-Armitage test to examine trends over time.

Results: Of 598,813 delivery hospitalizations identified, 2.77% (n=16,604) had codes for PPH. 78.4% (n=12,856) of PPH cases were identified by the sole code for uterine atony. PPH overall increased by 47.5% from 2008 to 2012 (2.23% to 3.29%, p<0.001), while uterine atony increased by 52.3% (1.76% to 2.68%, p<0.001) and other types of hemorrhage increased by 33% (0.51 to 0.68%, p<0.001). Of hospitalizations with PPH, 21.9% and 3.4% also had codes for blood transfusion and hysterectomy, respectively.

Conclusions: While overall PPH trends and the relative contribution of uterine atony were comparable to national estimates, the proportion of PPH cases in NYC receiving blood transfusions or hysterectomies was substantially higher. More research is needed to determine if these procedures represent early recognition and treatment, or more severe cases of PPH.