Postpartum haemorrhage in nulliparous women in relation to induction and augmentation of labour and mode of birth from 2000 -2020: a population-based cohort study in the Netherlands

Objective: To describe the annual incidence over time of postpartum haemorrhage (PPH) in the Netherlands as documented in routine birth statistics, stratified by induction of labour, augmentation of labour and mode of birth for nulliparous women. Design Population-based cohort study. Setting Nationwide. Population All nulliparous women who gave birth after 22 weeks’ gestation in the Netherlands between January 1, 2000, and December 31, 2020 (n=1,568,279). Methods This study used the Dutch Perinatal Registry (Perined) from 2000 to 2020. PPH trends were analyzed for nulliparous women based on mode of birth, induction and/or augmentation of labour. Main outcome measures PPH, defined as blood loss of >1000 ml. Results Documented PPH increased from 4.4% to 7.0 % of all births between 2000 and 2009, after which the rate stabilized until 2020. In the entire period, PPH rates were higher after vaginal birth compared to caesarean section. Induction of labour was consistently correlated with higher PPH rates, which increased further in the presence of augmentation. The sharp increase in all groups in the first decade occurred after guide line adjustments and introduction of the mandatory training for health professionals active in obstetric acute care: the Managing Obstetric Emergencies and Trauma (MOET) course, particularly after caesarean section, and indicates that better objectifiable measurements of blood loss might have played a role. Conclusion After an initial increase, the documented rate of PPH stabilized in the Netherlands. Induction and augmentation of labour are associated with a higher risk of PPH.