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Clinical Obstetrics

Poster Session 3

(860) Increasing postpartum hemorrhage and blood product transfusion at delivery in the United States, 2016-2020

Wednesday, February 14, 2024

8:30 AM – 10:00 AM

Location: Prince George's Exhibit Hall CDE, Lower Atrium Level

Primary & Presenting Author(s)

Rauvynne N. Sangara, MD (she/her/hers)

MFM Fellow
University of Southern California
Pasadena, CA, United States

Coauthor(s)

Shakeela Faulkner, MD (she/her/hers)

MFM Fellow
Keck School of Medicine of USC
Los Angeles, CA, United States
Emi Komatsu, MD

Los Angeles General Hospital + USC Medical Center
Los Angeles, CA, United States
KM

Kazuhide Matsushima, MD

Los Angeles General Hospital + USC Medical Center
Los Angeles, CA, United States
RM

Rachel S. Mandelbaum, MD

Los Angeles General Hospital + USC Medical Center
Los Angeles, CA, United States
BG

Brendan Grubbs, MD

Los Angeles General Hospital + USC Medical Center
Los Angeles, CA, United States
MI

Marc H. Incerpi, MD

Clinical Professor of Obstetrics and Gynecology
Los Angeles General Hospital + USC Medical Center
Los Angeles, CA, United States
JO

Joseph G. Ouzounian, MBA, MD

Professor and Chair of Obstetrics & Gynecology
Los Angeles General Hospital + USC Medical Center
Los Angeles, CA, United States
KM

Koji Matsuo, MD, PhD

Los Angeles General Hospital + USC Medical Center
Los Angeles, CA, United States

Objective: To evaluate temporal trends of postpartum hemorrhage (PPH) and blood product transfusion at delivery in the United States.

Study Design: This cross-sectional study queried the Healthcare Cost and Utilization’s National Inpatient Sample. The study population was 18,067,310 hospital deliveries from 1/2016-12/2020. The main outcome measures were incidence of PPH and performance of blood product transfusion at delivery according to the Center for Disease Control and Prevention (CDC) definition, including red blood cells, fibrinogen, plasma, platelets, cryoprecipitate, and whole blood. Temporal trends were assessed with the Cochran-Armitage test.

Results: Annual delivery volume decreased from 3,754,681 to 3,427,085 from 2016-2020 (8.3% relative-decrease). The incidence of PPH was 400.0 per 10,000 deliveries. The diagnosis of PPH at delivery increased from 337.2 to 463.4 per 10,000 deliveries during the 5-year period (37.4% relative-increase, P-trend< 0.001). During the study period, 205,720 (113.9 per 10,000) patients received blood transfusion with any product type, including single product (n=180,415 [99.9 per 10,000]), two type products (n=15,270 [8.5 per 10,000]), and three or more type products (n=10,035 [5.6 per 10,000]). The number of patients receiving any blood product at delivery increased from 102.9 to 125.4 per 10,000 deliveries from 2016-2020 (21.9% relative-increase, P-trend< 0.001), including two product types from 7.7 to 9.6 per 10,000 deliveries (24.7% relative-increase, P-trend< 0.001) and three or more product types from 4.5 to 6.0 per 10,000 deliveries (33.3% relative-increase, P-trend< 0.001).

Conclusion: This nationwide analysis demonstrates an increasing trend of PPH diagnosis and utilization of blood transfusion at delivery, particularly with multiple products, despite an overall decrease in delivery volume in the recent years in the United States. In 2020, one in 80 patients received blood transfusion at delivery.