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Obstetric Quality and Safety

Poster Session 1

(163) Focused Assessment with Sonography for Trauma Associated with Faster Time to Intervention for Postpartum Hemorrhage

Tuesday, February 13, 2024
10:30 AM – 12:00 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Foundation Awardee

    Primary & Presenting Author(s)

  • Yaneve N. Fonge, MD

    University of Pittsburgh
    Pittsburgh, PA, United States

    • Coauthor(s)

  • HG

    Helen Gomez, MD

    Christiana Care Health Systems
    Newark, DE, United States

  • SA

    Shanice Akoto, MD

    Christiana Care Health Systems
    Newark, DE, United States

  • JD

    John Dibato, PhD

    Cooper University Medical Center
    Camden, NJ, United States

  • Matthew Hoffman, MD, MPH

    Marie E. Pinizzotto, M.D., Endowed Chair of Obstetrics and Gynecology at Christiana Care
    Christiana Care Health Systems
    Newark, DE, United States

Objective:

We sought to identify if using Focused Assessment with Sonography for Trauma (FAST) exams during the evaluation of postpartum hemorrhage (PPH) following cesarean delivery affects the time to interventions.


Study Design: This is a retrospective cohort study of cesarean deliveries (CD) between 2016-2020. Women ages 14-51 with a diagnosis of PPH were included. Patients with placenta accreta spectrum disorder identified at the time of CD were excluded.  Demographic and outcome data were compared between those who had a FAST exam for PPH evaluation and those who did not. The primary outcome was the time to a composite of interventions, including intensive care unit admission, reoperation, and interventional radiology procedure within 48hrs of delivery. Group allocation and outcomes were determined through chart review. Survival Models were used to assess differences in time to intervention between the two groups, while adjusting for potential confounders.

Results:

A total of 1,128 women with PPH following CD were included in this analysis. 113 (10.0%) had a FAST exam as part of their evaluation for hypotension (18%), tachycardia (11%), dizziness (5%), abdominal pain (21%), larger than expected decrease in hemoglobin (23%), or bleeding from the vagina or incision (18%). 18% of FAST exams were positive for hemoperitoneum. The  FAST group had a higher estimated blood loss (EBL) (1,952 mL vs 1,340 mL  p < 0.0001) and more PPH related significant maternal morbidity (SMM). All other demographic variables were balanced between groups. The mean time to intervention was 8 hours shorter in the FAST group. FAST patients received interventions on average 39.2 hrs after delivery and non-FAST patients received interventions 47.2 hrs after delivery (p < .0001). After adjusting for age, EBL, multiple gestation, fibroids, reason for PPH, and PPH related SMM, the FAST group still received interventions on average 5.5 hrs faster than those who did not (p < 0.0001).

Conclusion: Providers should utilize FAST exams as a first-line approach in the evaluation of PPH to decrease time to interventions and reduce maternal morbidity.