197: Opportunities for improvement: Incidence and risk factors for maternal mortality from postpartum hemorrhage in California


      To identify trends and risk factors for postpartum hemorrhage (PPH) and associated mortality in California.

      Study Design

      There were 138,316 cases of PPH from 1991 to 2000 identified in the California Health Discharge Database. Data analyzed included demographic information (age, race, geographic region) and clinical risk factors. Student′s t-test, chi-square test, ANOVA and logistic regression were used as indicated. Significance was set at p<0.01.


      The incidence of PPH in California increased from 1.7% to 2.4% (1992-2000). The rate of mortality remained generally unchanged over time. The incidence of PPH was higher in Northern California (3.4%) vs. Southern California (1.9%) and Central California (1.7%). The Los Angeles, Orange County, and Inland Empire regions had increased mortality, while the Bay Area was associated with decreased mortality. Women aged 30 years or more had increased mortality. Caucasians were about 40% less likely to die from PPH when compared to other ethnicities. The presence of hypertensive disorders (OR: 2.6), abruption (OR: 2.4), low transverse cesarean delivery (OR: 1.6), classical cesarean delivery (OR: 3.6), and hysterectomy (OR: 6.9), were all independently associated with an increased risk for PPH mortality. Manual placental extraction (OR: 0.495), episiotomy (OR: 0.285), and laceration repairs (OR: 0.376) were independently associated with a decreased risk of mortality. The mean length of stay and hospital charges were 9 days and $79,438 for cases with maternal mortality, compared to 2.6 days and $8,580 for those without, respectively.


      The incidence of PPH increased throughout the study period. There appears to be variation in PPH incidence and mortality based on geographical region and presence of various risk factors. This information can potentially identify patients at risk and initiate strategies for prevention.