Term of Award

Spring 2022

Degree Name

Doctor of Public Health in Public Health Leadership (Dr.P.H.)

Document Type and Release Option

Dissertation (open access)

Copyright Statement / License for Reuse

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


Department of Health Policy and Community Health

Committee Chair

Gulzar Shah

Committee Member 1

William Mase

Committee Member 2

Bettye Apenteng


Background: Postpartum hemorrhage (PPH) is one of the contributing factors to maternal morbidity and mortality that in addition to maternal risk factors, may be related to other factors such as obstetric practice and clinical management of postpartum hemorrhage. Therefore, this study aimed to explore the association of postpartum hemorrhage with characteristics and regions of hospital locations across the United States, as the outcomes may create opportunities to improve policies and protocols regarding PPH management more effectively. Method: A retrospective study was performed using the 2018 National Inpatient Sample (NIS) database. Low-risk delivery hospitalizations involving the third stage of labor with an index for PPH were selected. Postpartum hemorrhage is further categorized as third-stage hemorrhage, delayed and secondary PPH, other immediate PPH, and postpartum coagulation defects. Pearson chi-square tests and multivariable logistic regression models were performed to compare and examine the associations of the risk of PPH and PPH sub-categories with hospital characteristics and regions. Results: Postpartum hemorrhage occurred in approximately 4% of the sample. Among postpartum cases, other immediate PPH was the most common (80%) cause of PPH cases. Results also revealed that hospitals in the West region had some of the strongest associations in an increased risk of PPH and third-stage hemorrhage, while hospitals owned by private investors had significant associations in decreased risk of all four PPH subcategories. Conclusion: The associations of the risk of PPH and some of the PPH subcategories were significantly varied across regions and hospital characteristics. Preliminary research is needed to determine whether these variations are due to obstetric practice and management or other factors to construct strategies and cost-effective intervention programs that can be tailored to patient characteristics, regions, and hospital types.

Research Data and Supplementary Material