Trends in Postpartum Hemorrhage in High Resource Countries: A Review and Recommendations From the International Postpartum Hemorrhage Collaborative Group
Bibliographic record
Abstract
There is considerable evidence for increasing trends in the incidence of postpartum hemorrhage (PPH) over time. The aim of the present study was to investigate trends in the frequency and the severity of PPH in developed countries, and to assess potential causes for any observed trends. There was an increasing trend in PPH in Australia, Canada, the United Kingdom, and the United States. The increased incidence of PPH was limited solely to immediate/atonic PPH in Australia, Canada, and the United States. Increasing rates of severe adverse outcomes due to PPH were found in Australia, Canada, the United Kingdom, and the United States. The key recommendations of the Collaborative Group are as follows: in future revisions of the International Classification of Diseases, there should be separate codes for atonic PPH and other forms of PPH that occur in the first 24 hours after delivery of the placenta. Separate codes are also required for morbidly adherent placenta including placenta accreta, increta, and percreta. A standardized definition of PPH should be used in all countries. Research is needed to determine how current definitions are applied in practice to the coding of data. Improved methods of data collection are required including assessment of severity. Additional studies are required to determine whether increases in rate of PPH have occurred in other countries, and to evaluate the role of potential risk factors of PPH including obesity, increased duration of labor, and changes in management of the second and third stage. A key to reducing the severity of PPH and preventing adverse outcomes is enhanced training of maternity care staff in the assessment of blood loss and the monitoring of women following childbirth. Physicians should be more aware of the likelihood that the frequency and severity of PPH has increased and be more vigilant. The reported increased incidence of PPH is especially a problem in small hospitals with few deliveries. Such hospitals have limited access to equipment or drugs and lack adequate management protocols to treat women with unexpected severe PPH.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.010 | 0.019 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.004 | 0.005 |
| Bibliometrics | 0.016 | 0.014 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.003 |
| Open science | 0.003 | 0.002 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".