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Fatal Obstetrical Hemorrhage: A 20-Year Analysis From Ontario.
Carolina Lavin Venegas1, Kasim E Abdulaziz1, Joel Ray2
1Better Outcomes Registry & Network (BORN) Ontario, Ottawa, Ontario; Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario.
Journal of Obstetrics and Gynaecology Canada : JOGC = Journal D'Obstetrique Et Gynecologie Du Canada : JOGC
|September 14, 2025
Summary
Obstetric hemorrhage is a significant cause of maternal death, with most fatalities occurring within 12 days postpartum, often on the day of delivery. This study highlights the critical timing and causes of these devastating pregnancy-related deaths.
Area of Science:
- Obstetrics and Gynecology
- Maternal Health
- Public Health
Background:
- Obstetric hemorrhage is a primary driver of maternal mortality globally.
- Understanding the characteristics of these deaths is crucial for developing targeted interventions.
- Previous research indicates a need for more data on the timing and causes of obstetric hemorrhage fatalities.
Purpose of the Study:
- To examine the characteristics, subtypes, and timing of obstetric hemorrhage deaths.
- To analyze the causes and contributing factors of maternal deaths due to obstetric hemorrhage.
- To identify patterns and risk factors associated with obstetric hemorrhage fatalities within a universal healthcare system.
Main Methods:
- Secondary analysis of a 20-year retrospective cohort study using linked administrative data.
- Inclusion of 485 post-pregnancy deaths, with a focus on 46 deaths attributed to obstetric hemorrhage.
- Expert clinical review of obstetric hemorrhage deaths to determine the main cause and timing.
Main Results:
- Obstetric hemorrhage accounted for 9.5% of post-pregnancy deaths and 27% of pregnancy-related deaths.
- All 46 obstetric hemorrhage deaths occurred within 12 days postpartum, with 56.5% on the day of delivery.
- Leading causes included amniotic fluid embolism (19.6%), placental abruption (13.0%), and uterine rupture (10.9%), with uncertain causes in 30% of cases. Higher deprivation and weekend deliveries were associated with increased risk.
Conclusions:
- Obstetric hemorrhage remains a critical cause of maternal mortality, predominantly in the early postpartum period.
- The findings underscore the urgent need for immediate postpartum monitoring and rapid response protocols.
- This study provides essential data on maternal deaths from obstetric hemorrhage in Ontario, informing future prevention strategies.
