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Clinical Obstetrics

Poster Session 4

(980) Prevention of Obstetric Hemorrhage in Moderate and High Risk Patients: Addition of Prophylactic Misoprostol

Wednesday, February 14, 2024

1:00 PM – 2:30 PM

Location: Prince George's Exhibit Hall CDE, Lower Atrium Level

Primary & Presenting Author(s)

Ashlesha K. Dayal, MD (she/her/hers)

Associate Professor Clinical Obstetrics and Gynecology
NYP Queens/ Weill Cornell Medicine
Flushing, NY, United States

Coauthor(s)

Daniel Skupski, MD (he/him/his)

Professor, Obstetrics & Gynecology, Weill Cornell Medicine; Chief, Obstetrics and Gynecology
Weill Cornell Medicine
Flushing, NY, United States
LL

Liping Lu, MD, MS, PhD

Columbia University Dept Epidemiology Mailman School of Public Health, Columbia University
New York, NY, United States
SB

Shai Bejerano, MS

Vagelos College of Physician and Surgeons, Columbia University
New York, NY, United States
RC

Rosalyn Chan-Akeley, MD, MPH

Ob/Gyn Research Program Manager
NYP Queens
Flushing, NY, United States
DV

Dinakar Velagala, MBBS

Research assistant
NYP Queens
Flushing, NY, United States
Dena Goffman, MD (she/her/hers)

Professor, Women's Health in Obstetrics & Gynecology; Vice Chair, Quality & Patient Safety
New York Presbyterian, Columbia University Medical Center
New York, NY, United States

Objective: We sought to evaluate the impact of dual pharmacologic prophylaxis with oxytocin and misoprostol for patients at moderate or high risk for postpartum hemorrhage (PPH) on PPH rates, quantitative blood loss (QBL) amounts, and morbidities.

Study Design: A quality improvement initiative was undertaken including the addition of buccal misoprostol prophylaxis immediately after delivery for all patients with moderate or high risk for hemorrhage during pre-birth PPH risk assessment, 200 micrograms for moderate risk and 400 micrograms for high risk. ‘Oxytocin only’ prophylaxis was administered 6/2021 to 4/2022 and ‘dual agent’ prophylaxis was given 4/2022 to 3/2023. Inclusion criteria: deliveries > 20 weeks’ gestation with moderate or high-risk pre-birth PPH risk assessment. Exclusion criteria: missing QBL, gestational age < 20 weeks or low PPH risk. The primary outcome was QBL at delivery and total postpartum blood loss (PPBL). Secondary outcomes were PPH rate (> 1000 ml) and composite morbidity including hysterectomy, unanticipated surgical intervention, uterine artery embolization, coagulopathy, acidemia (pH < 7.35), hypothermia (Temp < 36.0), intubation > 24 hours, transfusion of > 4u RBC, ICU admission. Demographic, QBL and morbidity data were captured electronically with morbidities confirmed by chart review.

Results: With dual agent prophylaxis, multiple linear regression analysis showed significantly less QBL at delivery and total PPBL within 24 hours in those having cesarean delivery (Table) and logistic regression analysis showed a significant reduction in composite morbidity (Table).

Conclusion:

Dual agent prophylaxis with oxytocin and misoprostol immediately after delivery was associated with a significant reduction in PPH rates and composite morbidity in patients undergoing cesarean birth. Prospective studies are warranted to assess replicability and safety.