ArticlePregnancy (Hoboken, N.J.)2025
Treatment patterns and costs among hospital births with abnormal postpartum uterine bleeding and postpartum hemorrhage in the United States (2016-2022).
Article in Pregnancy (Hoboken, N.J.), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Postpartum hemorrhage (PPH) is the leading cause of maternal morbidity and mortality globally, and PPH rates in the United States are increasing. The current study describes treatment patterns and healthcare costs in abnormal postpartum uterine bleeding and PPH in the United States. Method: Utilizing data from the US Premier Hospital Database from January 2016 to March 2022, this study investigated treatment patterns for second-line uterotonics and tranexamic acid (TXA), as well as the incidence of PPH and associated severe maternal morbidity (SMM) events, treatment patterns, and total healthcare costs. The analysis included 5,345,753 inpatient admissions for deliveries, identified PPH through ICD-10 CM codes or administration of specified uterotonic medications beyond oxytocin. Results: A total of 787,964 (14.7%) individuals had PPH and/or received second-line uterotonics beyond oxytocin (methylergonovine maleate, carboprost, misoprostol) and/or TXA. Rates of second-line uterotonics/TXA and/or PPH increased from 12.1% in 2016 to 19.7% in 2022. Methylergonovine (51.9%) and misoprostol (47.0%) were the most used uterotonics. The mean ± SD SMM and nontransfusion SMM comorbidity scores were 6.8 ± 8.9 and 8.5 ± 12.4, respectively, and included common maternal risk factors such as advanced maternal age, anemia, prior cesarean delivery, and hypertensive disorders. Economic burden was high, particularly for individuals who required hysterectomy (vaginal births: $29,375 and cesarean births: $34,103), received uterine balloon tamponade (UBT; vaginal births: $12,605 and cesarean births: $20,188), and/or were treated with 3 or more second-line uterotonics/TXA (vaginal births: $10,084 and cesarean births: $16,288). Intensive care unit admissions and hysterectomies were more common in the 3-4 uterotonics/TXA groups (4.4% and 2.2%) and among those who received UBT (9.4% and 4.4%) than those who received < 3 uterotonics/TXA. Conclusion: Using second-line uterotonic/TXA use and PPH diagnosis codes, the observed rate of abnormal postpartum bleeding was higher than previously reported and associated with significant clinical and economic burden. Total costs increased with greater use of uterotonics/TXA, especially in cases involving UBT or SMM such as hysterectomy. Higher treatment intensity likely reflects escalation in response to more severe clinical presentations. These findings highlight the need for appropriate intervention, better treatment options, and preventive strategies to manage abnormal postpartum uterine bleeding and PPH.
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