Trends and outcomes in postpartum hemorrhage transfer: A single-center retrospective study

Abstract

Background: Postpartum hemorrhage (PPH) has been the leading cause of maternal death. However, no reports were focused on PPH transfer cases. Objectives: To investigate factors that contribute to changes in outcomes for patients transferred due to PPH, such as the massive blood transfusion rate. Methods: Gunma University Hospital is a tertiary center located in a rural city in Gunma Prefecture and serves postpartum emergency cases from all over the prefecture. An observational study was conducted on women transferred by ambulance to our center for PPH. We explored the annual temporal trends in the baseline characteristics and maternal outcomes from 2013 to 2023 using the Cochran–Armitage trend and linear regression tests. Results: During the study period, 124 patients were included in the analysis. The use of tranexamic acid and the number of facilities that adopted obstetric simulation training showed a significant upward trend from 0.0% in 2013 to 20.0% in 2023 (p < 0.01) and from 0.0% in 2013 to 90.0% in 2023 (p < 0.01), respectively. The massive blood transfusion (defined as ≥ 10 units of fresh frozen plasma or red blood cells) rate showed a significant downward trend from 66.7% in 2013 to 0.0% in 2023 (p < 0.01) or from 50.0% in 2013 to 30.0% in 2023 (p < 0.01), respectively. Conclusion: The outcomes of postpartum transfers due to PPH have improved over the last decade. This improvement may be associated with the use of tranexamic acid and the introduction of obstetric simulation training throughout the Gunma Prefecture.