Reported cases of extreme blood loss during or after childbirth have increased in Alaska over the past eight years, and an education initiative for health providers is planned as a response, state health officials said.

The cases are known as obstetric hemorrhage, which is defined as the loss of at least 1,000 milliliters — or more than 2 pints — of blood during pregnancy or within 24 hours of childbirth. It is the leading cause of maternal death globally. Nonfatal cases can also have long-term health consequences.

In Alaska, reported rates of obstetric hemorrhage increased from 7.9% of hospital deliveries from 2016 to 2019 to 9% of hospital deliveries from 2020 to 2023, according to a bulletin issued by the Alaska Division of Public Health’s epidemiology section.

Reported rates in Alaska increased for nearly all geographic regions and demographic groups in the period evaluated, the epidemiology bulletin said. However, it is not clear whether the statistics reflects a true increase in case numbers or better identification and reporting of cases, the bulletin noted.

The highest rates are in the southwestern part of the state, where 15.6% of hospital deliveries from 2020 to 2023 involved such hemorrhages, and the northern part of the state, where the rate during that period was 12.6%, according to the bulletin.

Among ethnic groups, Pacific Islanders had the highest rates of obstetric hemorrhage, at 14.2% of hospital deliveries from 2020 to 2023, according to the bulletin. Indigenous patients had the second highest rate, at 12.7% during those years, the bulletin said.

A new campaign to educate health providers about obstetric hemorrhage will be launched in January by the Alaska Perinatal Quality Collaborative, a volunteer group of maternity health care specialists from around the state.

Rebekah Porter, a nurse consultant with the Alaska Division of Public Health and an author of the bulletin, described the plans for that initiative.

“The Alaska Perinatal Quality Collaborative’s Obstetric Hemorrhage Initiative will focus on both prevention and treatment of obstetric hemorrhage by promoting evidence-based change ideas that facilities can select based on their specific needs,” she said by email.

Through education and use of an American College of Obstetricians and Gynecologists tool called the Obstetric Hemorrhage Patient Safety Bundle, “the initiative aims to standardize care, improve outcomes, and enhance the readiness of healthcare providers across the state,” Porter said.

Excessive bleeding after childbirth causes about 70,000 maternal deaths a year, according to the World Health Organization. Those deaths are concentrated in low-income nations.

In Alaska, bleeding-related maternal deaths are rare.

From 2012 to 2016, there were no recorded maternal deaths in Alaska that were attributed to obstetric hemorrhage, according to state data. In the past five years, there have been fewer than five cases, Porter said.

However, health officials who are monitoring what is known as “severe maternal morbidity” – defined as unexpected outcomes of labor and delivery that have severe health impacts – have noticed an uptick in hemorrhage cases in recent years, Porter said. 

“This increase is another key reason for launching the AKPQC initiative at this time,” she said.

Most pregnancy-related deaths in Alaska are from some kind of trauma rather than from pregnancy-related medical causes, with domestic violence a prominent feature, according to state records. Unintentional injuries, homicides, assaults, suicides and overdoses together accounted for about two-thirds of pregnancy-related deaths from 2015 to 2019, according to state records.

Nationally, rates of hemorrhage after childbirth have increased over the past two decades, according to a study published last year by the National Institutes of Health. From 2000 to 2019, the rate of postpartum hemorrhage increased from 2.7% to 4.3%, the study said.