GUIDING PUBLIC POLICIES FOR THE MANAGEMENT OF POSTPARTUM HEMORRHAGE IN BRAZIL: AN EPIDEMIOLOGICAL ANALYSIS OF THE LAST 15 YEARS
DOI:
https://doi.org/10.56238/arev8n3-152Keywords:
Postpartum Hemorrhage, Public Health, Maternal Mortality, Time Series StudiesAbstract
Postpartum hemorrhage (PPH) remains one of the leading preventable causes of maternal mortality in Brazil, reflecting structural inequalities in access and quality of obstetric care. This study aimed to analyze the temporal trend of hospitalizations and deaths due to PPH in Brazil from 2009 to 2024, as well as to characterize its epidemiological profile. This is an ecological time-series study, using secondary data from the Hospital Information System (SIH) and the Mortality Information System (SIM), available in DATASUS. The coefficients were calculated using the number of live births as the denominator, standardized by age based on the World Health Organization's standard population. Trends were analyzed using joinpoint regression, with estimates of the annual percentage change (VPA) and respective 95% confidence intervals. Higher mortality from PPH was observed in the North and Northeast regions, while the South and Southeast regions presented lower coefficients. Only the Central-West region showed a significant upward trend in mortality (VPA=3.82; p<0.05). Hospitalizations were more frequent in the Southeast, but with higher rates in the South. Young women (20–29 years old) and those of mixed race/color predominated. The results highlight persistent regional and racial inequalities in the occurrence and outcomes of postpartum hemorrhage (PPH), suggesting limitations in the effectiveness of existing public policies. It is concluded that, despite institutional advances, mortality from PPH remains stable in most of the country, indicating a need to restructure care strategies, with an emphasis on regionally tailored public health policies, improvement of obstetric care and strengthening of health surveillance.
Downloads
References
ATLAS DE DESENVOLVIMENTO HUMANO NO BRASIL. Pnud Brasil, Ipea e FJP, 2022. Disponível em: <http://www.atlasbrasil.org.br/consulta/planilha>.
BETTI, T. et al. Prevalência dos fatores de risco para hemorragia pós-parto primária em um hospital universitário. Revista Brasileira de Enfermagem, v. 76, n. 5, p. 1-10, 2023. DOI: https://doi.org/10.1590/0034-7167-2022-0134
BITTENCOURT, S. D. DE A. et al. Atenção ao parto e nascimento em Maternidades da Rede Cegonha/Brasil: avaliação do grau de implantação das ações. Ciência & Saúde Coletiva, v. 26, n. 3, p. 801–821, 2021. DOI: https://doi.org/10.1590/1413-81232021263.08102020
CIARAVOLO, L. C. F. et al. Tendência da mortalidade materna por hemorragia pós-parto no Brasil: análise de séries temporais (2000–2023). Rev Rene, v. 26, p. e95738, 2025. DOI: https://doi.org/10.36517/2175-6783.20252695738
FEDERAÇÃO BRASILEIRA DAS ASSOCIAÇÕES DE GINECOLOGIA E OBSTETRÍCIA (FEBRASGO). Hemorragia pós-parto. São Paulo: FEBRASGO; 2021.
FERREIRA, K. C. et al. Cesarianas no brasil: uma análise epidemiológica das tendências e seus fatores determinantes (2000 – 2023). Revista Contemporânea, v. 5, n. 1, p. e7338, 2025. DOI: https://doi.org/10.56083/RCV5N1-083
FREITAS, P. S. M. D. et al. Análise da hemorragia pós-parto no brasil entre 2019 e 2023. Brazilian Journal of Implantology and Health Sciences, v. 6, n. 4, p. 1079–1093, 2024. DOI: https://doi.org/10.36557/2674-8169.2024v6n4p1079-1093
GLENZER, M. M. et al. Postpartum hemorrhage in Sub-Saharan Africa—a prospective study in metropolitan Mozambique. Journal of Thrombosis and Haemostasis, v. 21, n. 12, p. 3463–3476, 2023. DOI: https://doi.org/10.1016/j.jtha.2023.09.002
LEAL, M. DO C. et al. Redução das iniquidades sociais no acesso às tecnologias apropriadas ao parto na Rede Cegonha. Ciência & Saúde Coletiva, v. 26, n. 3, p. 823–835, 2021. DOI: https://doi.org/10.1590/1413-81232021263.06642020
FIGUEIREDO, E. R. L. et al. Influence of sociodemographic and obstetric factors on maternal mortality in Brazil from 2011 to 2021. BMC Women’s Health, v. 24, n. 1, p. 1-14, 2024. DOI: https://doi.org/10.1186/s12905-024-02925-3
LIU, C. et al. Prevalence and risk factors of severe postpartum hemorrhage: a retrospective cohort study. BMC Pregnancy and Childbirth, v. 21, n. 1, p. 1-8, 2021. DOI: https://doi.org/10.1186/s12884-021-03818-1
MELO, J. P. G. et al. Qualidade do cuidado pré-natal e parto no Brasil: comparação entre a Pesquisa Nacional de Saúde de 2013 e 2019. Ciência & Saúde Coletiva, v. 30, n. 9, p. 1-14, 2025. DOI: https://doi.org/10.1590/1413-81232025309.13162024
NIGUSSIE, J. et al. Magnitude of postpartum hemorrhage and its associated factors in Ethiopia: a systematic review and meta-analysis. Reproductive Health, v. 19, n. 1, p. 1-13, 2022. DOI: https://doi.org/10.1186/s12978-022-01360-7
OMOTAYO, M. O. et al. Prenatal anemia and postpartum hemorrhage risk: A systematic review and meta‐analysis. Journal of Obstetrics and Gynaecology Research, v. 47, n. 8, p. 2565–2576, 2021 DOI: https://doi.org/10.1111/jog.14834
ORGANIZAÇÃO PAN-AMERICANA DE SAÚDE. Manual de orientação para o curso de prevenção de manejo obstétrico da hemorragia: Zero Morte Materna por Hemorragia. Brasília: OPAS, 2018.
ORGANIZAÇÃO PAN-AMERICANA DE SAÚDE. Recomendações assistenciais para prevenção, diagnóstico e tratamento da hemorragia obstétrica. Brasília: OPAS, 2018.
PADILHA, K. et al. Internações por hemorragia pós-parto: um retrato do norte do brasil. Hematology, Transfusion and Cell Therapy, v. 46, p. S1103, 2024. DOI: https://doi.org/10.1016/j.htct.2024.09.1931
PIRES, R. C. R. et al. Tendências temporais e projeções de cesariana no Brasil, macrorregiões administrativas e unidades federativas. Ciência & Saúde Coletiva, v. 28, n. 7, p. 2119–2133, 2023. DOI: https://doi.org/10.1590/1413-81232023287.14152022en
ROCHA FILHO, E. A. et al. Severe maternal morbidity and near miss due to postpartum hemorrhage in a national multicenter surveillance study. International Journal of Gynecology & Obstetrics, v. 128, n. 2, p. 131–136, 2014. DOI: https://doi.org/10.1016/j.ijgo.2014.08.023
SALVIANO, F. W. B. et al. Acompanhamento pré-natal no Brasil: análise da proporção de gestantes com atendimento adequado. HU Revista, [S. l.], v. 51, p. 1–7, 2025.
SANTOS, M. C. C. DOS et al. Perfil epidemiológico da mortalidade materna por hemorragia pós-parto no brasil no período de 2018 a 2022. Revista Ibero-Americana de Humanidades, Ciências e Educação, v. 11, n. 1, p. 1115–1123, 2025. DOI: https://doi.org/10.51891/rease.v11i1.17819
SANTOS, Y. R. P. et al. Satisfaction with childbirth care in Brazilian maternity hospitals participating in the Stork Network program: women’s opinions. Cadernos de Saúde Pública, v. 39, n. 5, p. 1-13, 2023. DOI: https://doi.org/10.1590/0102-311xen154522
SAY, L. et al. Global causes of maternal death: a WHO systematic analysis. The Lancet Global Health, v. 2, n. 6, p. e323–e333, 2014. DOI: https://doi.org/10.1016/S2214-109X(14)70227-X
SILVA, L. B. R. A. DE A. et al. Avaliação da Rede Cegonha: devolutiva dos resultados para as maternidades no Brasil. Ciência & Saúde Coletiva, v. 26, n. 3, p. 931–940, 2021. DOI: https://doi.org/10.1590/1413-81232021263.25782020
SILVEIRA, M. M. P. DA et al. Mortalidade materna em uma maternidade para gestação de alto risco de uma cidade do estado da Bahia. Revista Eletrônica Acervo Saúde, v. 24, n. 7, p. e17016, 2024. DOI: https://doi.org/10.25248/reas.e17016.2024
UEDA, A. et al. Impact of efforts to prevent maternal deaths due to obstetric hemorrhage on trends in epidemiology and management of severe postpartum hemorrhage in Japan: a nationwide retrospective study. BMC Pregnancy and Childbirth, v. 22, n. 1, p. 1-9, 2022. DOI: https://doi.org/10.1186/s12884-022-04824-7
WORLD HEALTH ORGANIZATION. Trends in maternal mortality 2000 to 2020: estimates by WHO, UNICEF, UNFPA, World Bank Group and UNDESA/Population Division. Geneva: World Health Organization; 2023.
WORLD HEALTH ORGANIZATION. International Classification of Diseases Eleventh Revision (ICD-11). Geneva: World Health Organization; 2022.
WORLD HEALTH ORGANIZATION. Trends in maternal mortality estimates 2000 to 2023: estimates by WHO, UNICEF, UNFPA, World Bank Group and UNDESA/Population Division. Geneva: World Health Organization; 2025.
YUNAS, I. et al. Causes of and risk factors for postpartum haemorrhage: a systematic review and meta-analysis. The Lancet, v. 405, n. 10488, p. 1468-1480, 2025. DOI: https://doi.org/10.1016/S0140-6736(25)00448-9
