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Oral Concurrent Session 9 - Quality

Oral Concurrent Sessions

Oral Concurrent Session 9 - Quality

(91) Postpartum hemorrhage trends and outcomes before, during, and after a statewide obstetric quality improvement effort

Friday, February 13, 2026
8:15 AM - 8:30 AM  
Location: Summit 218 - 221

    Presenting Author(s)

  • Ellen Winter, BA (she/her/hers)

    Columbia University
    New York, New York, United States

    • Coauthor(s)

  • TW

    Timothy Wen, MD

    UCSD
    Irvine, California, United States

  • Mary E. D'Alton, MD

    Obstetrician and Gynecologist-in-Chief Willard C. Rappleye Professor and Chair
    Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center
    New York, New York, United States

  • DG

    Dena Goffman, MD

    Columbia University
    New York, New York, United States

    • Submitting Author(s)

  • Alexander M. Friedman, MD

    Columbia University
    New York, New York, United States

Objective:

The NY Safe Motherhood Initiative (SMI), a statewide quality improvement effort, was convened in 2013 and included 117 of the 123 hospitals in NY State. A bundle to optimize management of obstetric hemorrhage was developed and disseminated. The purpose of this study was to evaluate trends in statewide postpartum hemorrhage (PPH) outcomes.

Study Design:

Delivery hospitalizations in the 2007-2022 NY State Inpatient Database (SID) were analyzed for this repeated cross-sectional analysis. The NY SID includes discharge data for all inpatient acute-care hospitalizations in NY. For analyses, trends in PPH diagnoses among all delivery hospitalizations were first performed. Then, among deliveries with PPH, the following adverse outcomes were trended: (i) transfusion, (ii) non-transfusion severe maternal morbidity (SMM), (iii) disseminated intravascular coagulation (DIC), and (iv) hysterectomy. Analyses were performed with joinpoint regression to determine the average annual percent change (AAPC).

Results:

Among 3,693,509 delivery hospitalizations, PPH increased continuously from 2.2% in 2007 to 5.9% in 2022 (AAPC 6.9%, 95% CI 6.5%, 7.5%) (Figure 1). In joinpoint analysis, transfusion among deliveries with PPH increased from 2007 to 2013 (AAPC 2.1%, 95% CI 0.6%, 6.6%) but then decreased from 2013 to 2016 (AAPC -6.8%, 95% CI -9.5%, -2.1%) before increasing again from 2016 to 2022 (Figure 2). SMM increased from 2007 to 2014 (AAPC 2.8%, 95% CI 0.7%, 7.6%) before decreasing from 2014 to 2017 (AAPC -16.3%, 95% CI -20.8%, -8.4%), before rising again from 2017 to 2022 (AAPC 4.4%, 95% CI 0.1%, 18.5%). DIC increased from 2007 to 2014, decreased from 2014 to 2017 (AAPC -19.3%, 95% CI -25.3%, -8.9%) and increased non-significantly from 2017 to 2022. Hysterectomy decreased significantly from 2013 to 2022 (AAPC -10.2%, 95% -14.3%, 8.7%).

Conclusion:
The initiation of the NY SMI was associated with decreased risk for a range of adverse outcomes among deliveries with PPH. Decreases in risk continued for approximately 3-4 years after initiation of the program with the exception of hysterectomy which decreased continuously.