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Clinical Obstetrics

Poster Session 4

(923) The July Phenomenon and Postpartum Hemorrhagic Morbidity

Wednesday, February 14, 2024
1:00 PM – 2:30 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective: The “July Phenomenon” refers to the time of year when inexperienced physicians begin training and there is a concern for increase in adverse outcomes. We aimed to evaluate differences in composite of maternal hemorrhagic morbidity (CMHM) over four calendar quartiles to determine the putative impact of the “July Phenomenon”.

Study Design: Our retrospective cohort study included all singleton deliveries at an academic Level IV center from July 2020 to June 2021. A total of 4,151 deliveries were included and divided into four quartiles designed to follow one academic year: Quartile 1 (July to September, n=1073), Quartile 2 (October to December, n=1066), Quartile 3 (January to March, n=1011), and Quartile 4 (April to June, n=1001). The data was collected by trained clinicians. CMHM was defined as blood loss ≥ 1000 mL, use of uterotonics (excluding prophylactic oxytocin), mechanical tamponade, surgical techniques for atony, transfusion, venous thromboembolism, intensive care unit (ICU) admission, hysterectomy, or maternal death. CMHM in Quartiles 1, 2, and 3 were compared to Quartile 4 (when residents are most experienced) using multivariate Poisson regression with robust error variance, adjusted for variables identified in the univariate analysis.

Results: Compared to Quartile 4, there was no significant difference in CMHM with Quartile 1 (aRR 1.01, 95% CI 0.86 – 1.2), Quartile 2 (aRR 0.95, 95% CI 0.8 – 1.12) or Quartile 3 (aRR 1.13, 95% CI 0.96 – 1.33) (Figure 1). Majority of the components of the composite investigated did not differ between the Quartiles, except in surgical techniques where there was a significant increase in Quartile 4. Admission to ICU was significantly lower in Quartile 2, however this was no longer significant when admissions for COVID were excluded.

Conclusion: There was no “July phenomenon” for obstetrical hemorrhagic morbidity at our institution. Whilst surgical techniques differ as residents get more experienced, most components of the composite remained unchanged during a year.