{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T12:23:02Z","timestamp":1785414182651,"version":"3.56.0"},"reference-count":41,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2020,12,18]],"date-time":"2020-12-18T00:00:00Z","timestamp":1608249600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Postpartum hemorrhage (PPH) is the leading cause of direct maternal mortality globally and in Suriname. We aimed to study the prevalence, risk indicators, causes, and management of PPH to identify opportunities for PPH reduction.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>A nationwide retrospective descriptive study of all hospital deliveries in Suriname in 2017 was performed. Logistic regression analysis was applied to identify risk indicators for PPH (\u2265 500ml blood loss). Management of severe PPH (blood loss \u22651,000ml or \u2265500ml with hypotension or at least three transfusions) was evaluated via a criteria-based audit using the national guideline.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>In 2017, the prevalence of PPH and severe PPH in Suriname was 9.2% (n = 808\/8,747) and 2.5% (n = 220\/8,747), respectively. PPH varied from 5.8% to 15.8% across the hospitals. Risk indicators associated with severe PPH included being of African descent (Maroon aOR 2.1[95%CI 1.3\u20133.3], Creole aOR 1.8[95%CI 1.1\u20133.0]), multiple pregnancy (aOR 3.4[95%CI 1.7\u20137.1]), delivery in Hospital D (aOR 2.4[95%CI 1.7\u20133.4]), cesarean section (aOR 3.9[95%CI 2.9\u20135.3]), stillbirth (aOR 6.4 [95%CI 3.4\u201312.2]), preterm birth (aOR 2.1[95%CI 1.3\u20133.2]), and macrosomia (aOR 2.8 [95%CI 1.5\u20135.0]). Uterine atony (56.7%, n = 102\/180[missing 40]) and retained placenta (19.4%, n = 35\/180[missing 40]), were the main causes of severe PPH. A criteria-based audit revealed that women with severe PPH received prophylactic oxytocin in 61.3% (n = 95\/155[missing 65]), oxytocin treatment in 68.8% (n = 106\/154[missing 66]), and tranexamic acid in 4.9% (n = 5\/103[missing 117]).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>PPH prevalence and risk indicators in Suriname were similar to international and regional reports. Inconsistent blood loss measurement, varied maternal and perinatal characteristics, and variable guideline adherence contributed to interhospital prevalence variation. PPH reduction in Suriname can be achieved through prevention by practicing active management of the third stage of labor in every birth and considering risk factors, early recognition by objective and consistent blood loss measurement, and prompt treatment by adequate administration of oxytocin and tranexamic acid according to national guidelines.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0244087","type":"journal-article","created":{"date-parts":[[2020,12,18]],"date-time":"2020-12-18T18:49:12Z","timestamp":1608317352000},"page":"e0244087","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":13,"title":["Postpartum hemorrhage in Suriname: A national descriptive study of hospital births and an audit of case management"],"prefix":"10.1371","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2129-9796","authenticated-orcid":true,"given":"Lachmi R.","family":"Kodan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kim J. 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M.","family":"Bloemenkamp","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antoon W.","family":"Grunberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2020,12,18]]},"reference":[{"issue":"6","key":"pone.0244087.ref001","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1016\/S2214-109X(14)70227-X","article-title":"Global causes of maternal death: A WHO systematic analysis","volume":"2","author":"L Say","year":"2014","journal-title":"Lancet Glob Heal"},{"issue":"4\u20135","key":"pone.0244087.ref002","first-page":"203","article-title":"Obstetric transition in the World Health Organization Multicountry Survey on Maternal and Newborn Health: Exploring pathways for maternal mortality reduction","volume":"37","author":"S Da Cruz Chaves","year":"2015","journal-title":"Pan Am J Public Heal"},{"key":"pone.0244087.ref003","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1186\/s12884-015-0619-8","article-title":"Maternal near miss and mortality in a tertiary care hospital in Rwanda","volume":"15","author":"S Rulisa","year":"2015","journal-title":"BMC Pregnancy Childbirth"},{"key":"pone.0244087.ref004","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1471-2393-9-55","article-title":"Trends in postpartum hemorrhage in high resource countries: A review and recommendations from the international postpartum hemorrhage collaborative group","volume":"9","author":"M Knight","year":"2009","journal-title":"BMC Pregnancy Childbirth"},{"issue":"10","key":"pone.0244087.ref005","doi-asserted-by":"crossref","first-page":"1104","DOI":"10.1111\/aogs.12950","article-title":"Increasing incidence of postpartum hemorrhage: the Dutch piece of the puzzle","volume":"95","author":"G van Stralen","year":"2016","journal-title":"Acta Obstet Gynecol Scand"},{"issue":"12","key":"pone.0244087.ref006","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1371\/journal.pone.0081959","article-title":"Pre-eclampsia increases the risk of postpartum haemorrhage: A nationwide cohort study in The Netherlands","volume":"8","author":"JF Von Schmidt Auf Altenstadt","year":"2013","journal-title":"PLoS One"},{"issue":"10056","key":"pone.0244087.ref007","doi-asserted-by":"crossref","first-page":"2176","DOI":"10.1016\/S0140-6736(16)31472-6","article-title":"Beyond too little, too late and too much, too soon: a pathway towards evidence-based, respectful maternity care worldwide","volume":"388","author":"S Miller","year":"2016","journal-title":"Lancet"},{"key":"pone.0244087.ref008","unstructured":"World Health Organization. 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