Postpartum hemorrhage: Findings of a global survey by the World Association of Trainees in Obstetrics and Gynecology ( WATOG )

Postpartum hemorrhage (PPH) remains the leading cause of maternal mortality globally. This global survey was conducted to identify any disparities in the causes, prevalence, treatment, and mortality burden of PPH, with the aim of proposing relevant recommendations to bridge these disparities and ultimately reduce the global maternal mortality and morbidity burden of PPH. A cross-sectional survey of maternity care providers worldwide was conducted by the World Association of Trainees in Obstetrics and Gynecology (WATOG) in collaboration with International Federation of Gynecology and Obstetrics (FIGO) Childbirth and PPH Committee. The study instrument was a 15-item structured electronic questionnaire, designed using Google Forms®. The questionnaire included multiple choice and short answer questions on the baseline characteristics of respondents, causes, prevalence, treatment modalities, and mortality from PPH. The questionnaire was electronically distributed via WATOG and FIGO social media channels to study participants. In total, 339 responses were received from 64 countries in six regions, including Africa, Asia, Europe, North America, South America, and Oceania. The majority (n = 182, 53.7%) of respondents reported seeing an average of at least 10 cases of PPH in their hospitals each month. More respondents in low- and middle-income countries (LMICs) in Africa and Asia reported seeing more than 10 PPH cases monthly, compared to those in high-income countries in Europe and America (57.1% vs. 49.2%, P < 0.001). Most (n = 318, 93.8%) respondents volunteered that their hospitals recorded less than five PPH-related maternal mortalities monthly. All (n = 8, 2.4%) respondents who reported more than five PPH-related maternal mortalities were based in LMICs in Africa. Only 133 (39.2%) respondents reported availability of the non-pneumatic anti-shock garment (NASG) in their hospitals. Of those who reported non-availability of the NASG, 60% were in LMICs. The most common treatment for intractable PPH were uterine compression sutures (n = 177, 52.2%) and hysterectomy (n = 128, 37.8%). Less than 1 in 10 (n = 30, 8.8%) reported availability of vascular ligation and embolization procedures. PPH remains a significant obstetric complication globally, with a higher morbidity and mortality burden in LMICs. There is an urgent need for concerted global efforts to reduce maternal morbidity and mortality from PPH, especially in LMICs.