• W R Sheldon, J Blum, J P Vogel, J P Souza, A M Gülmezoglu, B Winikoff, and WHO Multicountry Survey on Maternal and Newborn Health Research Network.
• Gynuity Health Projects, New York, NY, USA.
• BJOG. 2014 Mar 1;121 Suppl 1:5-13.

ObjectiveTo explore the clinical practices, risks, and maternal outcomes associated with postpartum haemorrhage (PPH).DesignSecondary analysis of cross-sectional data.SettingA total of 352 health facilities in 28 countries.SampleA total of 274 985 women giving birth between 1 May 2010 and 31 December 2011.MethodsWe used multivariate logistic regression to examine factors associated with PPH among all births, and the Pearson chi-square test to examine correlates of severe maternal outcomes (SMOs) among women with PPH. All analyses adjust for facility- and country-level clustering.Main Outcome MeasuresPPH, SMOs, and clinical practices for the management of PPH.ResultsOf all the women included in the analysis, 95.3% received uterotonic prophylaxis and the reported rate of PPH was 1.2%. Factors significantly associated with PPH diagnosis included age, parity, gestational age, induction of labour, caesarean section, and geographic region. Among those with PPH, 92.7% received uterotonics for treatment, and 17.2% had an SMO. There were significant differences in the incidence of SMOs by age, parity, gestational age, anaemia, education, receipt of uterotonics for prophylaxis or treatment, referral from another facility, and Human Development Index (HDI) group. The rates of death were highest in countries with low or medium HDIs.ConclusionsAmong women with PPH, disparities in the incidence of severe maternal outcomes persist, even among facilities that report capacity to provide all essential emergency obstetric interventions. This highlights the need for better information about the role of institutional capacity, including quality of care, in PPH-related morbidity and mortality.© 2014 RCOG The World Health Organization retains copyright and all other rights in the manuscript of this article as submitted for publication.

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