Reported cases of extreme blood loss during or after childbirth have increased in Alaska over the past eight years, and an education initiative for health care providers is planned in response, health officials said of the state.
The cases are known as obstetric hemorrhagewhich is defined as the loss of at least 1,000 milliliters – or more than 2 pints – of blood during pregnancy or within 24 hours of giving birth. This is the main cause of maternal mortality worldwide. Non-fatal cases may also have long-term health consequences.
In Alaska, reported rates of obstetric hemorrhage increased from 7.9% of hospital deliveries from 2016 to 2019 to 9% of hospital deliveries from 2020 to 2023, according to a study. newsletter published by the Epidemiology Section of the Alaska Division of Public Health.
Rates reported in Alaska increased in nearly all geographic regions and demographic groups during the period assessed, the epidemiology bulletin said. However, it is unclear whether the statistics reflect a true increase in cases or better identification and reporting of cases, the bulletin notes.
The highest rates are in the southwestern part of the state, where 15.6% of hospital deliveries between 2020 and 2023 involved such hemorrhages, and in the northern part of the state, where the rate during that period was 12.6%, according to the bulletin.
Among ethnic groups, Pacific Islanders had the highest rates of obstetric hemorrhage, accounting for 14.2% of hospital deliveries between 2020 and 2023, according to the bulletin. Indigenous patients had the second highest rate, at 12.7% during those years, the report card said.
A new campaign to educate health care providers about obstetric hemorrhage will be launched in January by the Alaska Perinatal Quality Collaborative, a volunteer group of maternity care specialists from across the state.
Rebekah Porter, nurse consultant with the Alaska Division of Public Health and author of the newsletter, described plans for the initiative.
“The Alaska Perinatal Quality Collaborative’s Obstetric Hemorrhage Initiative will focus on both prevention and treatment of obstetric hemorrhage by promoting evidence-based change ideas that facilities can select based on their specific needs,” she said via email.
Through education and use of a tool from the American College of Obstetricians and Gynecologists called the Obstetric Hemorrhage Patient Safety Bundle“The initiative aims to standardize care, improve outcomes and strengthen the readiness of health care providers across the state,” Porter said.
Excessive bleeding after childbirth causes about 70,000 maternal deaths a year, according to the World Health Organization. These deaths are concentrated in low-income countries.
In Alaska, maternal deaths related to hemorrhage are rare.
From 2012 to 2016, there were no recorded maternal deaths in Alaska attributed to obstetric hemorrhage, according to state data. In the past five years, there have been fewer than five cases, Porter said.
However, health officials who monitor what is called “severe maternal morbidity“—defined as unexpected outcomes of labor and delivery that have serious health impacts—have noticed an increase in cases of hemorrhage in recent years, Porter said.
“This increase is another key reason for launching the AKPQC initiative at this time,” she said.
Most pregnancy-related deaths in Alaska are due to some sort of trauma rather than pregnancy-related medical causes, with domestic violence an important feature, according to state records. Unintentional injuries, homicides, assaults, suicides and overdoses together accounted for about two-thirds of pregnancy-related deaths between 2015 and 2019, according to state records.
Nationally, rates of postpartum hemorrhage have increased over the past two decades, a study finds. study published last year by the National Institutes of Health. From 2000 to 2019, the rate of postpartum hemorrhage increased from 2.7% to 4.3%, according to the study.
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