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Q&A

Clinical Obstetrics

Poster Session 3

(792) Medium postpartum hemorrhage risk: do multiple medium risk factors increase risk to high?

Wednesday, February 14, 2024
8:30 AM – 10:00 AM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective:

 

The ACOG Practice Bulletin on Postpartum hemorrhage (PPH; #183) suggests that all parturients be risk stratified into low-, medium- and high-risk. We  noticed that within medium-risk, the composite maternal hemorrhagic outcome (CMHO) rate varied by the number of risk factors. Thus, we hypothesized that parturient with 2 or more medium risk factors would have significantly higher rates of CMHO compared to those with only one medium risk factor.

Study Design:

This is a retrospective cohort study of all singleton gestations delivered at a Level-IV center within one year. The components of CMHO are described in the table. Chi-squared and Kruskal Wallis analysis was used to compare categorical variables. The adjusted relative risks (aRR) of CMHO and its components were calculated between the studied groups using Poisson regression, adjusted for confounders from the univariate analysis.

Results:

Of the 4,544 deliveries, 1,376 (30%) were cataloged as medium risk, and within those, 1,132 (82%) had one medium risk factor and 244 (18%) had more than 1. Patents were significant different in maternal age, race, Marial status, insurance type, BMI at delivery, gestational age, diabetes and hypertension diagnosis. The three most common “medium” risk factors were: prior uterine surgery (n-738, 54%), prolonged oxytocin use (292, 21%) or magnesium sulfate use at delivery (n=282, 20%). The risk for CMHO was significantly higher in those with two or more medium risk factors compared to a single risk factor (aRR 0.78, 95% CI (0.63-0.98). This difference is largely driven by uterotonic use, which was significantly higher in the multiple medium risk factor group compared to the single medium risk factor groups (aRR 0.67, 95% CI 0.51 – 0.88

Conclusion:

In our study population, participants with two or more medium PPH risk factors had a higher rate of CMHO than those with a single medium risk factor, largely driven by treatment for atony, and may be more appropriately treated as high-risk.