{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T23:59:13Z","timestamp":1791849553992,"version":"4.3.4"},"reference-count":34,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2011,12,13]],"date-time":"2011-12-13T00:00:00Z","timestamp":1323734400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2012,2]]},"abstract":"<jats:p><jats:italic>Please cite this paper as:<\/jats:italic> Lutomski J, Byrne B, Devane D, Greene R. Increasing trends in atonic postpartum haemorrhage in Ireland: an 11\u2010year population\u2010based cohort study. BJOG 2011; DOI: 10.1111\/j.1471\u20100528.2011.03198.x<\/jats:p><jats:p><jats:bold>Objective\u2002<\/jats:bold> To derive nationally representative incidence rates of postpartum haemorrhage (PPH), and to investigate trends associated with method of delivery, blood transfusion and morbidly adherent placenta (accreta, percreta and increta).<\/jats:p><jats:p><jats:bold>Design\u2002<\/jats:bold> Population\u2010based retrospective cohort study.<\/jats:p><jats:p><jats:bold>Setting\u2002<\/jats:bold> Republic of Ireland.<\/jats:p><jats:p><jats:bold>Population\u2002<\/jats:bold> Childbirth hospitalisations during the period 1999\u20132009.<\/jats:p><jats:p><jats:bold>Methods\u2002<\/jats:bold> International Classification of Diseases (ICD)\u20109\u2010CM and ICD\u201010\u2010AM diagnostic codes from hospital discharge records were used to identify cases of PPH. Significant temporal trends in PPH incidence were determined using Cochrane\u2013Armitage tests for trend. Log\u2010binomial regression was conducted to assess annual changes in the risk of PPH diagnosis, with adjustment for potential confounding factors.<\/jats:p><jats:p><jats:bold>Main outcome measures\u2002<\/jats:bold> PPH, uterine atony, blood transfusion and morbidly adherent placenta.<\/jats:p><jats:p><jats:bold>Results\u2002<\/jats:bold> A total of 649\u2003019 childbirth hospitalisations were recorded; 2.6% (<jats:italic>n<\/jats:italic>\u2003=\u200316\u2003909) included a diagnosis of PPH. The overall PPH rate increased from 1.5% in 1999 to 4.1% in 2009; atonic PPH rose from 1.0% in 1999 to 3.4% in 2009. Significant increasing trends in atonic PPH rates were observed across vaginal, instrumental, and emergency and elective caesarean deliveries (<jats:italic>P\u2003<\/jats:italic>&lt;\u20030.001). The rate of atonic PPH co\u2010diagnosed with blood transfusion also significantly increased (<jats:italic>P\u2003<\/jats:italic>&lt;\u20030.001). Relative to 1999, the risk of atonic PPH in 2009 was three\u2010fold increased (adjusted RR 3.03; 95% CI 2.76\u20133.34). Women diagnosed with a morbidly adherent placenta had a markedly higher risk of total PPH (unadjusted RR 13.14; 95% CI 11.43\u201315.11).<\/jats:p><jats:p><jats:bold>Conclusions\u2002<\/jats:bold> Increasing rates of atonic PPH highlight the pressing need for research and for clinical audit focusing on aetiological factors, preventative measures and quality of care, to guide current clinical practice.<\/jats:p>","DOI":"10.1111\/j.1471-0528.2011.03198.x","type":"journal-article","created":{"date-parts":[[2011,12,13]],"date-time":"2011-12-13T14:21:06Z","timestamp":1323786066000},"page":"306-314","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":193,"title":["Increasing trends in atonic postpartum haemorrhage in Ireland: an 11\u2010year population\u2010based cohort study"],"prefix":"10.1111","volume":"119","author":[{"given":"JE","family":"Lutomski","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"BM","family":"Byrne","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D","family":"Devane","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"RA","family":"Greene","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2011,12,13]]},"reference":[{"key":"e_1_2_10_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijgo.2007.03.011"},{"key":"e_1_2_10_3_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2007.01316.x"},{"key":"e_1_2_10_4_2","doi-asserted-by":"publisher","DOI":"10.1515\/jpm.2011.059"},{"key":"e_1_2_10_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2010.01.011"},{"key":"e_1_2_10_6_2","doi-asserted-by":"publisher","DOI":"10.3109\/00016349.2010.514324"},{"key":"e_1_2_10_7_2","unstructured":"NHS Quality Improvement Scotland.Scottish Confidential Audit of Severe Maternal Morbidity: 6th Annual Report Scotland;2010."},{"key":"e_1_2_10_8_2","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2393-9-55"},{"key":"e_1_2_10_9_2","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e31820ac074"},{"key":"e_1_2_10_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2008.11.008"},{"key":"e_1_2_10_11_2","first-page":"134","article-title":"Near miss maternal morbidity","volume":"101","author":"Lynch CM","year":"2008","journal-title":"Ir Med J"},{"key":"e_1_2_10_12_2","unstructured":"The Economic and Social Research Institute. 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