New York hospitals recorded fewer blood transfusions, severe maternal complications, and life-threatening clotting disorders among deliveries complicated by postpartum hemorrhage after implementing a statewide quality-improvement bundle, according to a recent study.
The program, introduced in 2013 and fully in place by mid-2014, was a statewide hospital-based effort designed to improve preparedness, identification, and treatment of postpartum hemorrhage. The analysis covered over 3.5 million hospital births in the state from 2007 to 2022.
Transfusion rates among women who experienced postpartum hemorrhage had risen steadily until 2013, when they declined to 174 per 1,000 in 2016 (AAPC −6.8%; 95% CI, −9.5% to −2.1%) before rising again to 212 per 1,000 in 2022. Severe maternal morbidity—complications serious enough to endanger life or long-term health—peaked at 122 per 1,000 in 2014 before declining to 76 per 1,000 in 2017 (AAPC −16.3%; 95% CI, −20.8% to −8.4%) and then rising again to 88 per 1,000 in 2022.
Disseminated intravascular coagulation, a dangerous clotting disorder, followed a similar pattern, increasing to 90 per 1,000 in 2014 before declining to 53 per 1,000 in 2017 (AAPC −19.3%; 95% CI, −25.3% to −8.9%). Hysterectomy rates decreased significantly from 26 per 1,000 in 2013 to 9 per 1,000 in 2022 (AAPC −10.2%; 95% CI, −14.3% to −8.7%).
The improvements in transfusion, severe maternal morbidity, and disseminated intravascular coagulation were temporary. By 2022, these rates had returned to levels comparable to those before the bundle was implemented. The study suggested that rising rates of obesity, diabetes, and other chronic conditions may have contributed to the reversal.
Postpartum hemorrhage occurs in 2% to 5% of pregnancies and remains a leading preventable cause of maternal death. A U.S. study found the rate increased from 2.7% in 2000 to 4.3% in 2019.
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Most women who experience it have no identifiable risk factors, making early detection and coordinated response essential. Safety reviews have repeatedly identified delays in these areas as preventable factors in poor outcomes.
The protocol’s impact on hysterectomies, often a last-resort procedure, indicates that quicker intervention may have helped some patients avoid fertility loss. However, the resurgence of other complications highlights the limits of process improvements alone.
The study used joinpoint regression to analyze annual trends. Postpartum hemorrhage diagnoses increased from 22 per 1,000 deliveries in 2007 to 59 per 1,000 in 2022 (AAPC 6.9%; 95% CI, 6.5–7.5%). Among those cases, transfusion rates dropped from 212 per 1,000 in 2013 to 174 per 1,000 in 2016 before returning to 212 per 1,000 by 2022.
Severe maternal morbidity among hemorrhage patients fell from 122 per 1,000 in 2014 to 76 per 1,000 in 2017, then rose again to 88 per 1,000 in 2022. Disseminated intravascular coagulation followed the same pattern. Only hysterectomies continued to decline, dropping from 26 per 1,000 in 2013 to 9 per 1,000 in 2022.
Adjusted models confirmed that the likelihood of hysterectomy decreased significantly in later years, even as other complications returned. The authors acknowledged that changes in patient risk factors may have influenced the results.
The findings appeared in Obstetrics & Gynecology.
