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dc.contributor.authorPrick, B.-
dc.contributor.authorvon Schmidt auf Altenstadt, J.-
dc.contributor.authorHukkelhoven, C.-
dc.contributor.authorBonsel, G.-
dc.contributor.authorSteegers, E.-
dc.contributor.authorMol, B.-
dc.contributor.authorSchutte, J.-
dc.contributor.authorBloemenkamp, K.-
dc.contributor.authorDuvekot, J.-
dc.identifier.citationBMC Pregnancy and Childbirth, 2015; 15(1):43-1-43-10-
dc.description.abstractThe incidence of severe postpartum hemorrhage (PPH) is increasing. Regional variation may be attributed to variation in provision of care, and as such contribute to this increasing incidence. We assessed reasons for regional variation in severe PPH in the Netherlands.We used the Netherlands Perinatal Registry and the Dutch Maternal Mortality Committee to study severe PPH incidences (defined as blood loss ≥ 1000 mL) across both regions and neighborhoods of cities among all deliveries between 2000 and 2008. We first calculated crude incidences. We then used logistic multilevel regression analyses, with hospital or midwife practice as second level to explore further reasons for the regional variation.We analyzed 1599867 deliveries in which the incidence of severe PPH was 4.5%. Crude incidences of severe PPH varied with factor three between regions while between neighborhoods variation was even larger. We could not explain regional variation by maternal characteristics (age, parity, ethnicity, socioeconomic status), pregnancy characteristics (singleton, gestational age, birth weight, pre-eclampsia, perinatal death), medical interventions (induction of labor, mode of delivery, perineal laceration, placental removal) and health care setting.In a nationwide study in The Netherlands, we observed wide practice variation in PPH. This variation could not be explained by maternal characteristics, pregnancy characteristics, medical interventions or health care setting. Regional variation is either unavoidable or subsequent to regional variation of a yet unregistered variable.-
dc.description.statementofresponsibilityBabette W Prick, Joost F von Schmidt auf Altenstadt, Chantal WPM Hukkelhoven, Gouke J Bonsel, Eric AP Steegers, Ben W Mol, Joke M Schutte, Kitty WM Bloemenkamp and Johannes J Duvekot-
dc.publisherBioMed Central-
dc.rights© 2015 Prick et al.; licensee BioMed Central. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.-
dc.subjectPostpartum Hemorrhage-
dc.subjectBirth Weight-
dc.subjectDelivery, Obstetric-
dc.subjectSeverity of Illness Index-
dc.subjectMaternal Mortality-
dc.subjectAnalysis of Variance-
dc.subjectRisk Factors-
dc.subjectCohort Studies-
dc.subjectGestational Age-
dc.subjectSocioeconomic Factors-
dc.subjectPractice Patterns, Physicians'-
dc.titleRegional differences in severe postpartum hemorrhage: a nationwide comparative study of 1.6 million deliveries-
dc.typeJournal article-
dc.identifier.orcidMol, B. [0000-0001-8337-550X]-
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