Postpartum hemorrhage increasing in Canada: UBC researchers

Growing numbers of Canadian women are suffering hemorrhages after giving birth, including severe blood loss requiring transfusions, hysterectomies or other emergency procedures to control the bleeding.

Researchers are struggling to understand the phenomenon.

A study involving more than two million deliveries in Canadian hospitals has found that the rate of postpartum hemorrhage increased by 22 per cent from 2003 to 2011, while hemorrhages requiring blood transfusions rose 37 per cent.

Postpartum hemorrhage is an obstetrical emergency that can be fatal. The sudden and extreme drop in blood volume can lead to kidney failure, respiratory distress syndrome and shock. It is the leading cause of preventable death among women giving birth worldwide. The study appears in the Journal of Obstetrics and Gynaecology Canada.

Using data from the Canadian Institute for Health Information, the researchers examined all hospital deliveries — 2,193,425 — between 2003 and 2011 in Canada ( excluding Quebec) that resulted in a live birth or stillbirth. There were 122,676 cases of postpartum hemorrhage.

The incidence of postpartum hemorrhage increased from 5.1 per cent of deliveries in 2003, to 6.2 per cent in 2010. Most of the increase was due to “uterine atony,” where the muscles of the uterus lose their tone, and can’t contract adequately to stop excess blood flow after delivery.

“If that uterus doesn’t contract down tightly, she can bleed very quickly, and bleed in a very large amount,” said Dr. Ellen Giesbrecht, senior medical director of acute services at BC Women’s Hospital & Health Centre.

“The extreme drop in blood volume can lead to really severe problems of the organs of the body not receiving enough blood, including the brain and the kidneys,” said lead author Azar Mehrabadi, a perinatal epidemiologist in the School of Population and Public Health at UBC.

BC Women’s Hospital is identifying mothers at risk for postpartum hemorrhage.

The hospital has developed protocols to intervene early to prevent hemorrhages from progressing from mild bleeding to serious blood loss.