{
    "abstract": "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.\nA 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.\nIn 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 1.3-3.3], Creole aOR 1.8[95%CI 1.1-3.0]), multiple pregnancy (aOR 3.4[95%CI 1.7-7.1]), delivery in Hospital D (aOR 2.4[95%CI 1.7-3.4]), cesarean section (aOR 3.9[95%CI 2.9-5.3]), stillbirth (aOR 6.4 [95%CI 3.4-12.2]), preterm birth (aOR 2.1[95%CI 1.3-3.2]), and macrosomia (aOR 2.8 [95%CI 1.5-5.0]). 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]).\nPPH 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.",
    "authors": [
        {
            "affiliation": "Department of Obstetrics and Gynecology, Academic Hospital Paramaribo, Paramaribo, Suriname, South Africa.\nDivision Women and Baby, Department of Obstetrics, Birth Centre Wilhelmina's Children Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.",
            "firstname": "Lachmi R",
            "initials": "LR",
            "lastname": "Kodan"
        },
        {
            "affiliation": "Division Women and Baby, Department of Obstetrics, Birth Centre Wilhelmina's Children Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.",
            "firstname": "Kim J C",
            "initials": "KJC",
            "lastname": "Verschueren"
        },
        {
            "affiliation": "Division Women and Baby, Department of Obstetrics, Birth Centre Wilhelmina's Children Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.",
            "firstname": "Zita D",
            "initials": "ZD",
            "lastname": "Pr\u00fcst"
        },
        {
            "affiliation": "Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.",
            "firstname": "Nicolaas P A",
            "initials": "NPA",
            "lastname": "Zuithoff"
        },
        {
            "affiliation": "Division Women and Baby, Department of Obstetrics, Birth Centre Wilhelmina's Children Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.\nJulius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.",
            "firstname": "Marcus J",
            "initials": "MJ",
            "lastname": "Rijken"
        },
        {
            "affiliation": "Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.",
            "firstname": "Joyce L",
            "initials": "JL",
            "lastname": "Browne"
        },
        {
            "affiliation": "Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.\nDivision of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.",
            "firstname": "Kerstin",
            "initials": "K",
            "lastname": "Klipstein-Grobusch"
        },
        {
            "affiliation": "Division Women and Baby, Department of Obstetrics, Birth Centre Wilhelmina's Children Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.",
            "firstname": "Kitty W M",
            "initials": "KWM",
            "lastname": "Bloemenkamp"
        },
        {
            "affiliation": "Board of Doctoral Graduations and Honorary Doctorate Awards, Anton de Kom University, Paramaribo, Suriname, South Africa.",
            "firstname": "Antoon W",
            "initials": "AW",
            "lastname": "Grunberg"
        }
    ],
    "conclusions": null,
    "copyrights": null,
    "doi": "10.1371/journal.pone.0244087\n10.1016/S2214-109X(14)70227-X\n10.1186/s12884-015-0619-8\n10.1111/aogs.12950\n10.1371/journal.pone.0081959\n10.1016/S0140-6736(16)31472-6\n10.1186/s12884-015-0473-8\n10.1371/journal.pone.0041114\n10.1016/j.bpobgyn.2008.08.004\n10.1177/1745505717716860\n10.1097/01.JAA.0000657164.11635.93\n10.1186/1471-2393-11-97\n10.1111/j.1600-0412.2011.01107.x\n10.1186/s12884-017-1466-6\n10.1186/s12913-019-4377-6\n10.7189/jogh.10.020429\n10.1016/j.ijsu.2014.07.013\n10.1055/s-0038-1639587\n10.1080/14767058.2016.1274302\n10.1186/s12978-016-0154-8\n10.1213/ANE.0b013e3181d74898\n10.1097/AOG.0b013e3181a66b05\n10.1016/j.ajog.2018.04.052\n10.1213/ANE.0b013e3182691e62\n10.1080/16549716.2020.1794105\n10.1002/14651858.CD007412.pub4\n10.1016/S0140-6736(17)30638-4\n10.1002/ijgo.13028",
    "journal": "PloS one",
    "keywords": [],
    "methods": null,
    "publication_date": "2020-12-19",
    "pubmed_id": "33338049\n25103301\n26208186\n26334634\n19943928\n27460955\n24367496\n27642019\n23586122\n25885884\n22844432\n18819848\n28681676\n32224823\n24641530\n22123123\n21332452\n28851302\n31500615\n33214899\n25046131\n29609191\n28002983\n27080710\n20237047\n19461428\n29752934\n22886840\n28484667\n32381099\n23586119\n32777997\n25730178\n26079202\n28456509\n29630190\n31709527",
    "results": "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 1.3-3.3], Creole aOR 1.8[95%CI 1.1-3.0]), multiple pregnancy (aOR 3.4[95%CI 1.7-7.1]), delivery in Hospital D (aOR 2.4[95%CI 1.7-3.4]), cesarean section (aOR 3.9[95%CI 2.9-5.3]), stillbirth (aOR 6.4 [95%CI 3.4-12.2]), preterm birth (aOR 2.1[95%CI 1.3-3.2]), and macrosomia (aOR 2.8 [95%CI 1.5-5.0]). 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]).",
    "title": "Postpartum hemorrhage in Suriname: A national descriptive study of hospital births and an audit of case management.",
    "xml": "<Element 'PubmedArticle' at 0x7885032d63e0>"
}