Background
Methods
An overview of the study
National database of health insurance claims
Guidelines, recommendations, and educational activities by the Societies in Japan
Patient identification
Primary and secondary endpoints
Statistical method
Results
Patient characteristics
2012 | 2013 | 2014 | 2015 | 2016 | 2017 | 2018 | Comparison between 2012 and 2018a | |
---|---|---|---|---|---|---|---|---|
Total number of deliveries, n | 1,037,231 | 1,029,816 | 1,003,539 | 1,005,677 | 976,978 | 946,065 | 918,397 | - |
Patients with severe PPH, n (rate per 1000 deliveries) | 3668 (3.54) | 4021 (3.90) | 4182 (4.17) | 4513 (4.49) | 4767 (4.88) | 5061 (5.35) | 5049 (5.50) | < .0001 |
Age, n (rate per 1000 deliveries) | 32.9 ± 5.3 | 33.0 ± 5.3 | 33.3 ± 5.3 | 33.4 ± 5.4 | 33.5 ± 5.3 | 33.3 ± 5.3 | 33.6 ± 5.4 | < .0001b |
≤ 19 | 30 (2.35) | 31 (2.39) | 33 (2.54) | 35 (2.93) | 33 (2.97) | 32 (3.23) | 34 (3.87) | .3232 |
20–24 | 203 (2.12) | 219 (2.40) | 190 (2.19) | 242 (2.87) | 220 (2.68) | 254 (3.20) | 228 (2.96) | .0135 |
25–29 | 712 (2.43) | 744 (2.63) | 762 (2.84) | 760 (2.90) | 823 (3.28) | 880 (3.65) | 888 (3.80) | < .0001 |
30–34 | 1217 (3.31) | 1322 (3.62) | 1354 (3.77) | 1452 (3.98) | 1528 (4.31) | 1697 (4.91) | 1614 (4.82) | < .0001 |
35–39 | 1150 (5.10) | 1289 (5.61) | 1369 (6.06) | 1438 (6.30) | 1544 (6.91) | 1603 (7.39) | 1611 (7.63) | < .0001 |
40–44 | 325 (7.73) | 395 (8.49) | 437 (8.81) | 550 (10.46) | 598 (11.18) | 568 (10.90) | 628 (12.25) | < .0001 |
45 ≤ | 31 (32.29) | 21 (18.82) | 37 (29.09) | 36 (27.52) | 21 (14.99) | 27 (17.86) | 46 (27.73) | .0247 |
Mode of delivery, n (% of patients with severe PPH) | ||||||||
Cesarean delivery | 1467 (40.0) | 1541 (38.3) | 1652 (39.5) | 1698 (37.6) | 1769 (37.1) | 1742 (34.4) | 1820 (36.0) | .0002 |
Operative vaginal delivery | 303 (8.3) | 393 (9.8) | 381 (9.1) | 466 (10.3) | 516 (10.8) | 563 (11.1) | 587 (11.6) | < .0001 |
Etiology of PPH, n (rate per 1000 deliveries) | ||||||||
Uterine atony | 1347 (1.30) | 1634 (1.59) | 1652 (1.65) | 1817 (1.81) | 1973 (2.02) | 2157 (2.28) | 2257 (2.46) | < .0001 |
Placenta previa | 467 (0.45) | 440 (0.43) | 462 (0.46) | 471 (0.47) | 513 (0.53) | 512 (0.54) | 528 (0.57) | .0001 |
Placenta accreta | 466 (0.45) | 559 (0.54) | 585 (0.58) | 650 (0.65) | 696 (0.71) | 780 (0.82) | 830 (0.90) | < .0001 |
Placenta previa accreta | 97 (0.09) | 105 (0.10) | 91 (0.09) | 110 (0.11) | 103 (0.11) | 99 (0.10) | 91 (0.10) | .6919 |
Retained placenta | 58 (0.06) | 75 (0.07) | 103 (0.1) | 130 (0.13) | 122 (0.12) | 134 (0.14) | 151 (0.16) | < .0001 |
Placental abruption | 635 (0.61) | 613 (0.60) | 666 (0.66) | 675 (0.67) | 622 (0.64) | 598 (0.63) | 528 (0.57) | .2857 |
Cases with IUFD | 162 (0.16) | 178 (0.17) | 150 (0.15) | 138 (0.14) | 132 (0.14) | 128 (0.14) | 96 (0.10) | .0017 |
Uterine rupture | 85 (0.08) | 86 (0.08) | 100 (0.10) | 98 (0.10) | 83 (0.08) | 97 (0.10) | 84 (0.09) | .4750 |
Uterine inversion | 132 (0.13) | 102 (0.10) | 120 (0.12) | 99 (0.10) | 98 (0.10) | 138 (0.15) | 101 (0.11) | .2690 |
Cervical laceration | 68 (0.07) | 54 (0.05) | 59 (0.06) | 72 (0.07) | 94 (0.10) | 101 (0.11) | 72 (0.08) | .2896 |
Vaginal hematoma | 253 (0.24) | 284 (0.28) | 293 (0.29) | 305 (0.30) | 342 (0.35) | 365 (0.39) | 324 (0.35) | < .0001 |
Cervical laceration with vaginal hematoma | 125 (0.12) | 153 (0.15) | 139 (0.14) | 178 (0.18) | 184 (0.19) | 205 (0.22) | 194 (0.21) | < .0001 |
Amniotic fluid embolism | 38 (0.04) | 37 (0.04) | 44 (0.04) | 52 (0.05) | 52 (0.05) | 57 (0.06) | 42 (0.05) | .3209 |
Multiple gestation | 141 (0.14) | 175 (0.17) | 173 (0.17) | 178 (0.18) | 218 (0.22) | 228 (0.24) | 252 (0.27) | < .0001 |
Transfusion volume and hemostatic procedures
2012 | 2013 | 2014 | 2015 | 2016 | 2017 | 2018 | |
---|---|---|---|---|---|---|---|
Patients with severe PPH, n | 3668 | 4021 | 4182 | 4513 | 4767 | 5061 | 5049 |
The transfusion volume, unit | |||||||
Red blood cells, mean ± SDa | 8.0 ± 7.7 | 8.2 ± 7.5 | 8.1 ± 8.1 | 8.3 ± 7.9 | 7.8 ± 6.9 | 7.5 ± 6.8 | 7.2 ± 6.3 |
Red blood cells, n (% of patients with severe PPH) | |||||||
0 | 176 (4.8) | 195 (4.8) | 230 (5.5) | 269 (6.0) | 279 (5.9) | 282 (5.6) | 315 (6.2) |
1–9 | 2609 (71.1) | 2757 (68.6) | 2942 (70.3) | 3060 (67.8) | 3317 (69.6) | 3646 (72.0) | 3699 (73.3) |
≥ 10 | 883 (24.1) | 1069 (26.6) | 1010 (24.2) | 1184 (26.2) | 1171 (24.6) | 1133 (22.4) | 1035 (20.5) |
Fresh frozen plasma, mean ± SDb | 9.5 ± 10.1 | 9.7 ± 10.0 | 9.9 ± 10.9 | 10.3 ± 10.7 | 9.6 ± 9.9 | 9.3 ± 9.7 | 8.7 ± 8.6 |
Fresh frozen plasma, n (% of patients with severe PPH) | |||||||
0 | 1358 (37.0) | 1352 (33.6) | 1257 (30.1) | 1294 (28.7) | 1343 (28.2) | 1453 (28.7) | 1491 (29.5) |
1–9 | 1566 (42.7) | 1733 (43.1) | 1904 (45.5) | 2044 (45.3) | 2285 (47.9) | 2427 (48.0) | 2506 (49.6) |
≥ 10 | 744 (20.3) | 936 (23.3) | 1021 (24.4) | 1175 (26.0) | 1139 (23.9) | 1181 (23.3) | 1052 (20.8) |
Platelet, mean ± SDc | 22.5 ± 16.7 | 21.9 ± 15.4 | 22.6 ± 17.7 | 22.5 ± 16.1 | 21.6 ± 16.8 | 22.0 ± 16.2 | 21.6 ± 16.5 |
Platelet, n (% of patients with severe PPH) | |||||||
0 | 3150 (85.9) | 3452 (85.8) | 3620 (86.6) | 3870 (85.8) | 4173 (87.5) | 4473 (88.4) | 4493 (89.0) |
1–10 | 171 (4.7) | 193 (4.8) | 180 (4.3) | 208 (4.6) | 193 (4.0) | 212 (4.2) | 185 (3.7) |
> 10 | 347 (9.5) | 376 (9.4) | 382 (9.1) | 435 (9.6) | 401 (8.4) | 376 (7.4) | 371 (7.3) |
Hemostatic procedures, n (% of patients with severe PPH) | |||||||
Intrauterine balloon tamponaded | 98 (2.4) | 331 (7.9) | 604 (13.4) | 717 (15.0) | 875 (17.3) | 1025 (20.3) | |
Arterial embolization | 174 (4.7) | 255 (6.3) | 300 (7.2) | 319 (7.1) | 324 (6.8) | 294 (5.8) | 291 (5.8) |
Hysterectomy | 320 (8.7) | 347 (8.6) | 291 (7.0) | 331 (7.3) | 323 (6.8) | 311 (6.1) | 313 (6.2) |
Hysterectomy and maternal mortality of patients with severe PPH
2013–2015 | 2016–2018 | p valueb | |
---|---|---|---|
Patient with severe PPH, n | 12,716 | 14,877 | - |
Total maternal deathsa, n | 133 | 128 | - |
Hysterectomy, n (% of patients with severe PPH) | 969 (7.6) | 947 (6.4) | < .0001 |
Maternal mortality due to severe PPH, n | 28 | 18 | - |
Case, per 100,000 deliveries | 0.92 | 0.63 | - |
Case, % of total maternal deathsa | 21.1 | 14.1 | .1384 |
Case in non-DPC facilities, n | 27 | 16 | - |