Perinatal & Pediatric
Postpartum Hemorrhage Trajectories in the United States Military Health System, 2013–2021 Sandra Maduforo* Sandra Maduforo Celeste J. Romano Clinton Hall Gia R. Gumbs Ava Marie S. Conlin
Background: A 2014 Military Health System (MHS) review identified higher rates of postpartum hemorrhage (PPH) at military vs civilian hospitals; by 2015, rates were reportedly similar. This work aimed to investigate trends in PPH in the MHS through 2021 and assess differences between military hospitals with distinct trajectories.
Methods: The Department of Defense Birth and Infant Health Research program was used to identify live born deliveries among US military families, 2013–2021. PPH was ascertained via diagnosis codes from delivery through 12 weeks postpartum. Annual rates of PPH were calculated by hospital type (military vs civilian) and for each military hospital. Military hospitals were then grouped by PPH rate trajectory: sustained high/increasing relative to other military hospitals (i.e., high), sustained low/decreasing (i.e., low), or variable. Risk factors were compared by trajectory.
Results: Among 643,065 identified deliveries, 45.5% occurred at a military hospital and 54.5% at a civilian hospital. Overall PPH rates at military hospitals declined from 2013-2015, falling below rates at civilian hospitals, but increased in subsequent years, exceeding pre-2015 rates at civilian and military hospitals. Compared to military hospitals with low (n=11) and variable (n=6) rate trajectories, those with high rate trajectories (n=14) had higher annual delivery counts (1206 high; 819 low; 958 variable), and deliveries were more likely to have several risk factors for PPH (e.g., preterm: 7.4% high; 4.8% low; 4.9% variable), but less likely to have others (e.g., anemia: 15.7% high; 18.9% low; 16.0% variable).
Conclusions: Despite an apparent decline in PPH at military hospitals from 2013-2015, rates rose from 2016–2021, with varying trajectories and associations with well-known risk factors. Findings suggest differences in measurement of PPH and warrant further assessment.
