Risk of life-threatening bleeding after childbirth quadruples in two decades
The risk of excessive bleeding or haemorrhage in women after childbirth has increased almost fourfold in Ireland in the last two decades. A landmark UCC study of more than a million births in hospital from 2005 to 2021 found over 5pc of women suffered a primary postpartum haemorrhage which involves losing over 500ml of blood within 24 hours of delivery. It is the most common and unpredictable complication of childbirth and the leading cause of maternal morbidity and mortality worldwide, according to the research team.
Irish hospital records revealed the leading associated risk factors for this type of post-childbirth haemorrhage included mothers over the age of 35, first-time mothers and women undergoing an emergency caesarean section.
“In the age ranges category, advanced maternal age was the highest association with bleeding,” said the study author, Imelda Fitzgerald from the Centre of Midwifery Education in Cork University Maternity Hospital.
“We looked at different ways infants are born, by vaginal birth, instrumental birth, elective caesarean section and emergency caesarean section and the emergency caesarean section group had the highest rate of postpartum haemorrhage.
“Another demographic we looked at were women who hadn’t given birth before compared to women who had given birth two or three times or more, and women who hadn’t given birth had the greatest risk factor in that group,” she said.
Over the 17-year study period, 60,041 new mothers in Ireland haemorrhaged after delivery — the risk nearly quadrupled from 2.5pc of childbirth cases in 2005 to 9.6pc in 2021. The research team, which included Professor Richard Greene, also found a significant jump in the rates of major obstetric haemorrhage where a woman loses more than 1.5 litres of blood after childbirth.
“Women who experience a mild or moderate primary postpartum haemorrhage require less intensive medical intervention, while women who experience a major obstetric haemorrhage will need a multidisciplinary team approach to treat and to prevent end-organ damage and risk to life,” according to the study.
The UCC team, who studied the in-patient enquiry database from 1,003,799 births, found 85pc of cases related to the womb failing to contract after delivery due to poor muscle tone, which is known medically as an atonic uterus.
A trauma-related cause such as unintentional cuts or tears during caesarean sections and episiotomies or relating to childbirth was associated with around 5pc of the primary postpartum haemorrhage cases.
Ms Fitzgerald said women may be more at risk of a heavier bleed after an emergency caesarean section.
Tissue-related causes such as placental complications were associated with 4pc of cases and causes related to clotting disorders, which are the rarest, were involved in only 0.5pc of cases, according to the study.
The research was published in the European Journal of Obstetrics and Gynecology and Reproductive Biology.
The National Women and Infants Health Programme and the National Perinatal Epidemiology Centre have established the Quality Improvement Initiative for Postpartum Haemorrhage to tackle the rising rates of haemorrhage.