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333121
Trends in postpartum hemorrhage among delivery hospitalizations in New York City 2008-2012


Tuesday, November 3, 2015

Meghan Angley, MPH, New York City Department of Health and Mental Hygiene, Long Island City, NY
Renata Howland, MPH, New York City Department of Health and Mental Hygiene, Long Island City, NY
Sang Hee Won, MPH, New York City Department of Health and Mental Hygiene, Long Island City, NY
Wendy C. Wilcox, MD, MPH, FACOG, Department of Obstetrics and Gynecology, North Bronx Healthcare Network (Jacobi Medical Center/North Central Bronx Hospital), Bronx, NY
Hannah Searing, MA-MHS, New York City Department of Health and Mental Hygiene, Long Island City, NY
Carla Clark, MPH, New York City Department of Health and Mental Hygiene, Long Island City, NY
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.

Learning Areas:

Clinical medicine applied in public health

Learning Objectives:
Describe postpartum hemorrhage trends among New York City delivery hospitalizations. Identify the proportion of postpartum hemorrhage cases that also indicate blood transfusion or hysterectomy.

Keyword(s): Maternal and Child Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am currently a Data Analyst for a local health department and work on two grant-funded projects related to maternal health and sexual and reproductive health.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.