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Clinical Obstetrics

Poster Session 4

(953) Quantitative blood loss and hemorrhage risk in patients taking antepartum SSRI and aspirin

Wednesday, February 14, 2024
1:00 PM – 2:30 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective:

Studies have shown taking an SSRI and an NSAID together increases the risk of bleeding events in other disciplines. The objective of this study was to investigate whether a similar relationship exists with SSRI and aspirin use and post-partum bleeding.

Study Design:

This was an IRB-approved retrospective chart review conducted at a single academic center. Data was abstracted from a total of 17,512 pregnancies between 2018 and 2023. Patients were characterized based on their medication use in pregnancy as documented in the electronic medical record.

Results:

Of these patients 1,283 took an SSRI alone, 1,541 took aspirin alone and 232 took both an SSRI and aspirin antepartum. Pre-delivery hemorrhage risk scores between groups showed high risk scores of: 26.5% neither medication, 28.7% SSRI only, 34.4% aspirin only, and 26.4% SSRI and aspirin. For patients with a vaginal delivery our analysis showed that patients taking an SSRI and aspirin had the highest average quantitative blood loss (QBL) with a mean of 492 mL. This relationship remained in a model adjusting for maternal age, parity, and gestational age (p=0.001). This group also had highest QBL in those with cesarean delivery, with average QBL of 928.5 mL. This relationship remained significant in our adjusted analysis. In all delivery types, patients taking aspirin and SSRI were most likely group to have a QBL > 500 for vaginal delivery and >1000 for cesarean delivery, in both an adjusted and unadjusted model (rate 38.8%, adj OR 2.10, 1.61-2.76, p< 0.001). A similar result was seen when looking at QBL > 1000 for all delivery types (adj OR 2.09, 1.56-2.79, p< 0.001).

Conclusion:

Patients taking an SSRI and aspirin in pregnancy had the highest average QBL, regardless of mode of delivery and were the most likely group to experience a post-partum hemorrhage in both unadjusted and adjusted models. Our study shows patients taking SSRI and aspirin may be at an increased likelihood of post-partum hemorrhage. Knowing this relationship can allow providers to appropriately counsel and monitor these patients during their delivery and in the post-partum period.