{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,11]],"date-time":"2025-12-11T03:05:48Z","timestamp":1765422348345,"version":"3.37.3"},"reference-count":30,"publisher":"BMJ","issue":"4","license":[{"start":{"date-parts":[[2024,4,3]],"date-time":"2024-04-03T00:00:00Z","timestamp":1712102400000},"content-version":"unspecified","delay-in-days":2,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Research and Development Program of China","award":["2021YFC2701500","2021YFC2701505"],"award-info":[{"award-number":["2021YFC2701500","2021YFC2701505"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2023,12,8]]},"published-print":{"date-parts":[[2024,4]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To identify the characteristics and treatment approaches for patients with severe postpartum haemorrhage (SPPH) in various midwifery institutions in one district in Beijing, especially those without identifiable antenatal PPH high-risk factors, to improve regional SPPH rescue capacity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Retrospective cohort study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>This study was conducted at 9 tertiary-level hospitals and 10 secondary-level hospitals in Haidian district of Beijing from January 2019 to December 2022.<\/jats:p><\/jats:sec><jats:sec><jats:title>Participants<\/jats:title><jats:p>The major inclusion criterion was SPPH with blood loss \u22651500\u2009mL or needing a packed blood product transfusion \u22651000\u2009mL within 24\u2009hours after birth. A total of 324 mothers with SPPH were reported to the Regional Obstetric Quality Control Office from 19 midwifery hospitals.<\/jats:p><\/jats:sec><jats:sec><jats:title>Outcome measures<\/jats:title><jats:p>The pregnancy characteristics collected included age at delivery, gestational weeks at delivery, height, parity, delivery mode, antenatal PPH high-risk factors, aetiology of PPH, bleeding amount, PPH complications, transfusion volume and PPH management. SPPH characteristics were compared between two levels of midwifery hospitals and their association with antenatal PPH high-risk factors was determined.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>SPPH was observed in 324 mothers out of 106\u2009697 mothers in the 4 years. There were 74.4% and 23.9% cases of SPPH without detectable antenatal PPH high-risk factors in secondary and tertiary midwifery hospitals, respectively. Primary uterine atony was the leading cause of SPPH in secondary midwifery hospitals, whereas placental-associated disorders were the leading causes in tertiary institutions. Rates of red blood cell transfusion over 10 units, unscheduled returns to the operating room and adverse PPH complications were higher in patients without antenatal PPH high-risk factors. Secondary hospitals had significantly higher rates of trauma compared with tertiary institutions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Examining SPPH cases at various institutional levels offers a more comprehensive view of regional SPPH management and enhances targeted training in this area.<\/jats:p><\/jats:sec>","DOI":"10.1136\/bmjopen-2023-077709","type":"journal-article","created":{"date-parts":[[2024,4,3]],"date-time":"2024-04-03T17:50:23Z","timestamp":1712166623000},"page":"e077709","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Characteristics and treatment for severe postpartum haemorrhage in different midwifery hospitals in one district of Beijing in China: an institution-based, retrospective cohort study"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-6036-8754","authenticated-orcid":false,"given":"Yike","family":"Yang","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yu","family":"Shao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Huan","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaoyue","family":"Guo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yingzhi","family":"Liang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yan","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yangyu","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2024,4,3]]},"reference":[{"key":"2024040310500843000_14.4.e077709.1","doi-asserted-by":"crossref","first-page":"1775","DOI":"10.1016\/S0140-6736(16)31470-2","article-title":"Global, regional, and national levels of maternal mortality, 1990\u20132015: a systematic analysis for the global burden of disease study 2015","volume":"388","author":"Kassebaum","year":"2016","journal-title":"The Lancet"},{"key":"2024040310500843000_14.4.e077709.2","doi-asserted-by":"crossref","DOI":"10.1186\/s12913-022-07721-z","article-title":"Risk management of pregnant women and the associated low maternal mortality from 2008\u20132017 in China: a national longitude study","volume":"22","author":"Liu","year":"2022","journal-title":"BMC Health Serv Res"},{"key":"2024040310500843000_14.4.e077709.3","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(14)70227-X"},{"key":"2024040310500843000_14.4.e077709.4","first-page":"237","article-title":"Study on cause and rate of maternal death in Beijing, 2010-2019","volume":"14","author":"Yang Hui-juan","year":"2020","journal-title":"Capital Journal of Public Health"},{"key":"2024040310500843000_14.4.e077709.5","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1002\/ijgo.14116","article-title":"FIGO recommendations on the management of postpartum hemorrhage 2022","volume":"157 Suppl 1","author":"Escobar","year":"2022","journal-title":"Int J Gynaecol Obstet"},{"key":"2024040310500843000_14.4.e077709.6","doi-asserted-by":"crossref","DOI":"10.1186\/s12884-019-2499-9","article-title":"Clinical characteristics of women captured by extending the definition of severe postpartum haemorrhage with 'Refractoriness to treatment': a cohort study","volume":"19","author":"Henriquez","year":"2019","journal-title":"BMC Pregnancy Childbirth"},{"key":"2024040310500843000_14.4.e077709.7","doi-asserted-by":"crossref","first-page":"e168","DOI":"10.1097\/AOG.0000000000002351","article-title":"ACOG practice bulletin No.183: postpartum hemorrhage","volume":"130","year":"2017","journal-title":"Obstet Gynecol"},{"key":"2024040310500843000_14.4.e077709.8","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1111\/1471-0528.14833","article-title":"Defining definitions: a Delphi study to develop a core outcome set for conditions of severe maternal morbidity","volume":"126","author":"Schaap","year":"2019","journal-title":"BJOG"},{"key":"2024040310500843000_14.4.e077709.9","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1513247"},{"key":"2024040310500843000_14.4.e077709.10","doi-asserted-by":"crossref","first-page":"50","DOI":"10.46234\/ccdcw2021.016","article-title":"The distribution of pregnant women with different pregnancy risks \u2014 4 cities, China, 2019","volume":"3","author":"Liu","year":"2021","journal-title":"China CDC Wkly"},{"key":"2024040310500843000_14.4.e077709.11","unstructured":"National Health Commission of the People\u2019s Republic of China . 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