Postpartum haemorrhage in nulliparous women in relation to induction and
augmentation of labour and mode of birth from 2000 -2020: a
population-based cohort study in the Netherlands
Abstract
Objective To describe the annual incidence over time of postpartum
haemorrhage (PPH) in the Netherlands as documented in routine birth
statistics, stratified by induction of labour, augmentation of labour
and mode of birth for nulliparous women. Design Population-based cohort
study. Setting Nationwide. Population All nulliparous women who gave
birth after 22 weeks’ gestation in the Netherlands between January 1,
2000, and December 31, 2020 (n=1,568,279). Methods This study used the
Dutch Perinatal Registry (Perined) from 2000 to 2020. PPH trends were
analyzed for nulliparous women based on mode of birth, induction and/or
augmentation of labour. Main outcome measures PPH, defined as blood loss
of >1000 ml. Results Documented PPH increased from 4.4% to
7.0 % of all births between 2000 and 2009, after which the rate
stabilized until 2020. In the entire period, PPH rates were higher after
vaginal birth compared to caesarean section. Induction of labour was
consistently correlated with higher PPH rates, which increased further
in the presence of augmentation. The sharp increase in all groups in the
first decade occurred after guide line adjustments and introduction of
the mandatory training for health professionals active in obstetric
acute care: the Managing Obstetric Emergencies and Trauma (MOET) course,
particularly after caesarean section, and indicates that better
objectifiable measurements of blood loss might have played a role.
Conclusion After an initial increase, the documented rate of PPH
stabilized in the Netherlands. Induction and augmentation of labour are
associated with a higher risk of PPH.