The Medical Direct Costs of Postpartum Hemorrhage in Mexico 2013-2020

OBJECTIVES: Globally, Postpartum hemorrhage (PPH) is a leading cause of maternal mortality and a significant contributor to severe maternal morbidity and long-term disability. PPH disproportionately affects low and middle-income countries. The objective was to identify and assess the medical direct costs of postpartum hemorrhage at the IMSS in Mexico from 2013 to 2020.

METHODS: A retrospective analysis using data obtained from databases and public information sources to estimate the use of IMSS resources for the target population. This retrospective study analyzed delivery hospitalizations classified as postpartum hemorrhage due to uterine atony (UA), delayed postpartum hemorrhage (DPH), retained placenta (RP) and postpartum coagulation defects (CD). Average length of stay and inpatient surgical procedures were compared between groups. Costs were calculated (mean and standard deviation) by using IMSS diagnostic-related groups 2017 (DRGs) and brought to present value based on inflation from INEGI (are presented in 2023 US dollars).

RESULTS: Among deliveries complicated by postpartum hemorrhage, 54.9% are for UA, DPH 23.1%, RP 18.8% and CD 3.2%. Women with UA had the highest average length of stay (3.3 days), CD (2.8 days), RP (2.7 days) and DPH 2.2 days. From the total of surgical procedures (20,519) 50.2% are associated to UA, 28.3% DPH, RP 18.6% and 2.9% for CD. Costs of hospital stay associated to postpartum hemorrhage from 2013 to 2020 reached $171,184,593.95 (62.5% UA, 17.5% for DPH and RP, for CD 3.1%). Surgical procedures total cost is $24,499,660.53 (51.1% UA, 28.2% for DPH, 18.5% associates to RP, for CD 2.0%).

CONCLUSIONS: Women with postpartum hemorrhage at the IMSS experienced significantly longer length of stay and higher surgical procedures. New interventions to reduce morbidity and mortality related to postpartum hemorrhage may facilitate delivery of more cost-effective care as well as overall improvements in maternal and population health.