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Labor

Poster Session 4

(971) Race and quantitative blood loss in postpartum hemorrhage

Wednesday, February 14, 2024
1:00 PM – 2:30 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective: Black patients are at a higher risk of morbidity and mortality from postpartum hemorrhage (PPH) than White patients in pregnancy. Inadequate estimation of blood loss (EBL) has been suggested as one possible contributing factor which could be mitigated with the adoption of quantitative blood loss (QBL). This study examined whether the transition from EBL to QBL impacted disparities in the magnitude of PPH. We hypothesized that the magnitude of PPH in Black patients with QBL would be higher, reflecting an underassessment with EBL.

Study Design: A retrospective cohort study of pregnant patients with documented PPH during delivery at a tertiary safety-net hospital between 2019-2021; QBL was formally implemented at the institution in April 2020. PPH was defined as > 1000mL for C-sections and > 500mL for vaginal deliveries. Patients with chorioamnionitis, macrosomia, multiple gestation, treatment with magnesium, or other diagnoses that influence blood loss were excluded. Included patients underwent chart review for demographic information and documented blood loss. Wilcox rank sum testing and transformation of the outcome variable via natural logarithms with subsequent t-testing were performed comparing EBL to QBL for Black and White patients.

Results:

429 patients were included. 192 patients delivered via C-section (50% Black) and 237 delivered vaginally (43% Black). When comparing QBL to EBL there was a statistically significant increase in average blood loss for C-sections in all patients. The difference was greater in Black (+167mL,p=0.004) versus white patients (+46mL,p=0.004). There was no statistically significant increase in average blood loss for spontaneous vaginal deliveries in Black (+34mL,p=0.5) or White women (-137mL,p=0.2).

Conclusion: While EBL tended to underestimate blood loss during C-sections for all patients, the difference was greater for Black patients. Objective tools such as QBL may impact disparities by reducing the potential for individual bias in patient assessment and should continue to be an important tool in PPH bundles of care.