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Clinical Obstetrics

Poster Session 4

(968) Post-Partum Hemorrhage Morbidity Among Obese versus Non-Obese Individuals

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

Obesity in pregnancy has been an unclear risk factor for postpartum hemorrhage (PPH) risk stratification, and ACOG Obesity in Pregnancy (#230) suggests that body mass index (BMI) ≥40 kg/m2  is a risk factor for atonic PPH only in vaginal deliveries. This study aimed to determine the effect of BMI >30 kg/m2 on PPH.


Study Design:
This retrospective cohort study was conducted on all singletons ≥14 weeks with recorded BMI who delivered at a Level IV center for two consecutive years. The exposure group was sub-categorized into BMI 30-39 and BMI ≥ 40 kg/m2, with a planned subgroup looking at route of delivery. Data was collected by clinicians, and the composite maternal hemorrhagic outcome (CMHO) was defined as: blood loss ≥ 1000 mL, interventions for atony including use of uterotonics (excluding prophylactic oxytocin), mechanical tamponade, surgical intervention, venous thromboembolism, admission to the intensive care unit, hysterectomy, or maternal death. Adjusted relative risks (aRR) with 95% confidence intervals (CI) were calculated using multivariate Poisson regression with robust error variance.


Results:
Of 8,623 deliveries in the study period, 8,340 (96.7%) met inclusion criteria, with 2943 (35%) having BMI < 30.0, 3,900 (46%) had a BMI of 30-39.9 kg/m2, and 1497 (17%) had a BMI of ≥40 kg/m2. CHMO was increased for BMI 30-39.9 (aRR 1.19, 95% CI 1.08-1.31) and ≥40.0 (aRR 1.22, 95% CI 1.09-1.38) (Table 1), largely due to increased risk of blood loss ≥ 1,000 mL (BMI 30-39.9: aRR 1.45, 95% CI 1.1901.75, BMI ≥40: aRR 1.67, 95% CI 1.35-2.07) and uterotonic use (BMI 30-39.9: aRR 1.24, 95% CI 1.11-1.4, BMI ≥40: aRR 1.37, 95% CI 1.04-1.59). A subgroup analysis of obese individuals and route of delivery noted that cesarean delivery compared to vaginal delivery among BMI 30-39.9 had an increased risk of CMHO in BMI 30-39.9 (aRR 1.61, 95% CI 1.41-1.85), but had no effect on BMI ≥40 (aRR 1.05, 95% CI 0.85-1.30).


Conclusion: Obese parturient had a higher risk of hemorrhage related morbidity compared to non-obese patients, with implications for counseling, risk stratification, and intervention trials