5,6 Despite lower estimates for PPH in developed countries compared with developing nations, several studies have noted an increase in PPH in high-resource regions. 6 The prevalence of PPH with 1000 mL blood loss or more was considerably lower in both reviews with overall estimates of 1.9 to 2.8 percent. 5 Estimates in another systematic review were higher, with similarly wide regional variation: 26 percent in Africa, 13 percent in North America and Europe, and 8 percent in Latin America and Asia.
5 A systematic review estimated prevalence of PPH with 500 mL of blood loss or more at 10.5 percent in Africa, 8.9 percent in Latin America and the Caribbean, 6.3 percent in North America and Europe, and 2.6 percent in Asia.
5,6 Rates vary by data source and country as well as assessment method with a prevalence of 10.6 percent when measured by objective appraisal of blood loss and 7.2 percent when assessed with subjective techniques. The overall prevalence of PPH worldwide is estimated to be 6 to 11 percent. In addition, PPH may be described as third or fourth stage depending on whether it occurs before or after delivery of the placenta respectively. 1 PPH is often classified as primary/immediate/early, occurring within 24 hours of birth, or secondary/delayed/late, occurring more than 24 hours post-birth to up to 12 weeks postpartum. 4 Proposed alternate metrics for defining and diagnosing PPH include change in hematocrit, need for transfusion, rapidity of blood loss, and changes in vital signs, all of which are complicated by the emergent nature of the condition.
1-4 Moreover, average blood loss at birth frequently exceeds 500 or 1000 mL. 1 Definitions vary, however, and are often based on inaccurate estimates of blood loss. Postpartum hemorrhage (PPH) is commonly defined as blood loss exceeding 500 mL following vaginal birth and 1000 mL following cesarean. Background and Objectives for the Systematic Review Definition and Prevalence
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