Major postpartum haemorrhage in nulliparous women stratified by induction and augmentation of labour and mode of birth from 2000 −2024: a population-based cohort study in the Netherlands

Objective To describe the rate of major postpartum haemorrhage (PPH) over time in the Netherlands as documented in routine birth statistics, stratified by induction of labour, augmentation of labour and mode of birth. Population All nulliparous women who gave birth to a singleton after 24 weeks' gestation in the Netherlands between January 1, 2000, and December 31, 2024 (n = 1,832,873). Methods This population-based cohort study used the Dutch Perinatal Registry (Perined). Documented major PPH (defined as blood loss 1000 mL or more within 24 h of giving birth) trends were analysed from 2000 to 2024, based on mode of birth, induction and augmentation of labour. Results Documented major PPH (≥1000 mL) increased from 4.3% to 6.6% of all births between 2000 and 2009, followed by a more stable period until approximately 2015 and a subsequent increase to 9,3% in 2024. Interrupted time-series analyses indicated that temporal trends differed across periods, with breakpoints corresponding to changes in measurement and registration practices. In the entire period, documented major PPHrates were higher after vaginal birth, in particular after induction, augmentation and assisted birth, compared to caesarean section, ranging from 3.9% to 8.6% and 3.6% to 7.8%, respectively. Induction of labour was associated with higher documented major PPH rates, which increased further in the presence of augmentation. Conclusion Documented major PPH (≥1000 mL) rates increased over the past 25 years across all birth groups in the Netherlands. These increases persisted after adjustment for measured maternal and obstetric characteristics. Additional factors, including changes in measurement practices and case ascertainment, may also contribute.