OBJECTIVES : Obstetric complications can range from mild discomfort to life-threatening conditions like, postpartum hemorrhage (PPH), preeclampsia, hypovolemia, sepsis, etc. However, the in-hospital mortality associated with obstetrical complications has not been rigorously studied. There is only one other nationally representative study using data from 2012-2013. Therefore, the objective of this study is to evaluate the in-hospital mortality associated with some of the common obstetric complications (PPH, secondary PPH, pre-eclampsia and uterine atony).

METHODS : We used National Inpatient Sample 2017, to identify women between the ages 18 and 50 who had a discharge code for birth. We performed chi-square test and logistic regressions to examine the association between obstetric complications and in-hospital mortality. In the regression model, we controlled for patient demographics, insurance, hospital characteristics, mode of delivery, multiparity and other complications such as hypovolemia, placenta previa, perineal trauma, etc.

RESULTS : There were 731,631 hospital births in 2017. In-hospital mortality was significantly higher among women with atonic PPH (AOR = 57.03, 95% CI = 7.16, 454.3), non-atonic PPH (AOR = 10.24, 95 CI = 4.96, 21.14), pre-eclampsia (AOR = 2.30, 95% CI = 1.13, 4.68) and placenta accreta (AOR = 5.71, 95% CI = 1.36, 24.05).

CONCLUSIONS : Although the overall rate of in-hospital mortality following childbirth is low, the risk is significantly higher among those with complications due to atonic or non-atonic PPH, pre-eclampsia and placenta accreta. Despite consistent efforts to identify the risk factors and provide interventions early, the rate of PPH and mortality due to PPH has increased marginally since 2013.