(336) Differences in pharmacologic management of postpartum hemorrhage in patients with and without thrombocytopenia

We performed a single-institution, retrospective cohort study on patients whose deliveries were complicated by PPH from 8/2020-11/2021. Inclusion criteria included quantitative blood loss ≥1000ml within 24 hours of delivery as defined by ACOG’s reVITALize criteria for PPH. Patients were stratified into two groups: those with thrombocytopenia on delivery admission with platelets < 150,000 per µl and those with platelets ≥150,000 per µl. The primary outcome was number of types of uterotonics used and number of administered doses for each uterotonic in PPH management. The secondary outcome was number of doses of tranexamic acid (TXA). All patients received standardized postpartum oxytocin regimen per institutional protocol.

Results:

µOf the 4298 patients who delivered during the study period, 529 (12%) patients experienced PPH. In patients who experienced PPH, 61 (11.5%) met definition for thrombocytopenia on admission. Body mass index was significantly lower in patients with thrombocytopenia, but otherwise, all other demographics were similar. Patients with thrombocytopenia were more likely to require 4 different types of uterotonics only if they underwent CD (14% vs 3%, p = 0.008). In addition, they were more likely to require more doses of carboprost (0 [0, 1.75] vs 0 [0, 0], p=0.04) and methylergonovine (0 [0, 1] vs 0 [0, 1], p=0.007) compared to patients without thrombocytopenia only if they required CD. There were no differences in the number of types of uterotonics used or doses of each uterotonic administered when patients underwent SVD. Rates of TXA administration were similar between groups.

Conclusion: Patients with thrombocytopenia (platelets < 150,000 per µl) require significantly more types of uterotonics and doses of carboprost and methylergonovine for pharmacologic management of PPH when undergoing CD.