DOI: 10.5061/dryad.q2bvq83rp
title: Data from: the characteristics and treatment for severe postpartum hemorrhage in different midwifery hospitals in one district of Beijing in China: an institution-based, retrospective cohort study

description: Objective: To identify the characteristics and treatment approaches for
 Severe Postpartum Hemorrhage (SPPH) patients in various midwifery
 institutions in one district in Beijing, especially those without
 identifiable antenatal PPH risk factors, to improve regional SPPH rescue
 capacity. Design: Retrospective cohort study Setting: This study was
 conducted at nine tertiary-level hospitals and ten
 secondary-level hospitals in Haidian district of Beijing from January 2019
 to December 2022. Participants: The major inclusion criterion was SPPH
 cases with blood loss ≥1500 ml or needing a packed blood product
 transfusion ≥1000 ml within 24 h after birth. A total of 324 mothers
 suffering from SPPH were reported to the Regional Obstetric Quality
 Control Office from 19 midwifery hospitals. Outcome measures: The
 pregnancy characteristics collected included: age at delivery, gestational
 weeks at delivery, height, parity, delivery mode, antenatal PPH risks,
 etiology of PPH, bleeding amount, PPH complications, transfusion amount,
 and PPH management. SPPH characteristics were compared between two levels
 of midwifery hospitals and their association with antenatal PPH high-risk
 factors was determined. Results: SPPH was observed in 324 mothers
 out of 106697 mothers in the four 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, accounting for over 50% of cases. In all SPPH cases, the
 rates of red blood cell transfusion over 10U, unscheduled returns to the
 operating room, and adverse PPH complications were higher in patients
 without antenatal PPH risk factors. Secondary hospitals had significantly
 higher rates of trauma compared with tertiary institutions. Conclusion:
 Examining SPPH cases at various institutional levels offers a more
 comprehensive view of regional SPPH management and enhances targeted
 training in this area.
description: Study area The Haidian district is 431 square
 kilometers in area, accounting for about 2.6% of Beijing’s landmass. At
 the end of 2021, the district had 3.130 million permanent residents,
 making it the second most populous in Beijing. The district has 19
 midwifery institutions, nine tertiary facilities (three serving as
 regional transferal centers), and ten secondary facilities. Primary
 midwifery institutions are mostly distributed in rural areas, and there
 are no primary midwifery institutions in this region.
 Study design and time frame A retrospective
 cohort study was conducted from January 2019 to December 2022.
 Participants The Beijing maternal management
 policy requires all midwifery institutions to prepare and submit monthly
 reports about severe perinatal complications to the Reginal Obstetric
 Quality Control Office (ROQCO). Such complications include abnormal vital
 signs (eclampsia, cyanosis, oliguria or anuria, coagulation disorders, and
 shock), abnormal laboratory inspections (lower oxygenation index,
 thrombocytopenia, abnormal liver, and renal functions), and incidences of
 specialized care (use of vasoactive agents, mechanical ventilation,
 hemofiltration, massive transfusion, and unplanned
 hysterectomy). All SPPH cases reported to ROQCO were
 selected. The inclusion criteria were: blood loss ≥1500 ml or the need for
 a packed blood product transfusion ≥1000 ml within 24 h after childbirth
 and gestational periods &gt;20 weeks. Figure 1 shows the
 flowchart. Data collection Data were
 collected and abstracted from case summaries submitted by 19 midwifery
 institutions to ROQCO in Beijing’s Haidian district. These summaries
 provide comprehensive information on cases of postpartum hemorrhage (PPH),
 including detailed demographics, pregnancy history, delivery outcomes, and
 emergency interventions. In detail, pregnancy variables such as age at
 delivery, gestational weeks, height, parity, delivery mode, antenatal PPH
 risks, etiology of PPH, bleeding amount, SPPH complications, transfusion
 amount, and PPH management were obtained. The word count ranges from 2000
 to 4000 Chinese characters. Antenatal PPH
 risks The Antenatal PPH risks considered were as
 outlined in the global PPH guidelines (7, 17-19). The classification of
 these risks was based on PPH etiology or assessment on admission, labor or
 perinatal. The most important antenatal factors were summarized as
 follows: 1. Placenta previa/placenta accreta; 2. Previous surgical
 procedures (more than two Cesarean Section (CS) surgeries or myomectomy);
 3. Intramural fibroid (≥5cm); 4. Multiple pregnancies; 5. Macrosomia; 6.
 History of PPH; 7. Anticoagulant medication/coagulation disorders
 (Fib/platelet reduction); 8. Severe preeclampsia/ HELLP syndrome; 9.
 Anemia (Hb≤9.0 g/dL). Statistical analysis
 All statistical analyses were performed using GraphPad Prism 9
 (GraphPad Software, San Diego, CA). The SPPH characteristics were
 expressed as means, standard deviation, number (n), and percentage (%).
 The qualitative variables were compared using the chi-square test,
 Fisher’s exact test, or an Unpaired t-test, as appropriate. The
 P-value&lt;0.05 was considered statistically significant.
description: # The characteristics and treatment for severe postpartum hemorrhage in
 different midwifery hospitals in one district of Beijing in China: an
 institution-based, retrospective cohort study
 Information on SPPH cases
 reported to ROQCO were conducted at nine tertiary-level hospitals and ten
 secondary-level hospitals in Haidian district of Beijing from January 2019
 to December 2022. The database was setup by Excel software. ## Description
 of the data and file structure Data were collected and abstracted from
 case summaries submitted by 19 midwifery institutions to ROQCO in
 Beijing’s Haidian district. These summaries provide comprehensive
 information on cases of postpartum hemorrhage (PPH), including detailed
 demographics, pregnancy history, delivery outcomes, and emergency
 interventions. In detail, pregnancy variables such as age at delivery,
 delivery mode, antenatal PPH high-risk factors, etiology of PPH, bleeding
 amount, SPPH complications like coagulation disorders and shock,
 transfusion volume, and PPH management were obtained. The presence of
 'N/A' and 'null' in cells indicated the absence of
 values or unrelated empty values, such as in the column denoting
 'time before Unplanned Exploratory Laparotomy,' where
 'N/A' represented cases without unplanned exploratory
 laparotomy, while 'null' denoted unknown values. Additionally,
 the data on manual removal of placenta and curettage has been collected in
 the database. However, due to incomplete information, this article does
 not provide a comprehensive discussion on these procedures.