(700) Risk Factors of Prostaglandin Failure in the Management of Postpartum Hemorrhage After Vaginal Delivery

To identify risk factors for prostaglandin E2 (sulprostone) failure in postpartum hemorrhage after vaginal delivery.

Study Design:

We conducted a secondary analysis of the TUB trial, a multicenter randomized trial assessing the efficacy of intrauterine balloon tamponade (IUBT) used simultaneously with prostaglandin versus its use after prostaglandin failure. We selected women of the control group who received standard care, i.e. prostaglandin administration and then IUBT if bleeding persisted. Prostaglandin failure was defined as the need for IUBT to stop bleeding. We compared maternal and labor characteristics according to prostaglandin failure. Multivariate logistic regression was used to identify independent risk factors for prostaglandin failure and calculate adjusted odds ratios with 95% confidence intervals.

Results:

Among the 193 women, 39 (20.2%) required IUBT for persistent bleeding despite prostaglandin administration. Maternal and labor characteristics did not differ between the groups. The mean time from birth to prostaglandin administration was 81±63 minutes in the success group and 76±55 minutes in the failure group (p-value .6). The rate of women receiving prostaglandin within 30 minutes after birth was 8.7% in the success group versus 10% in the failure group (p-value .8). The mean quantified blood loss at prostaglandin administration was 872 ± 286 mL in the success group and 955 ± 411 mL in the failure group (p-value .2). Thrombocytopenia (OR 15.8 [1.89-329], p-value .02) and multiple pregnancy (OR 2.76 [1.01-7.16], p-value .04) were identified as independent risk factors for prostaglandin failure.

Conclusion: Neither the time of administration of prostaglandins nor the amount of bleeding predicts failure of this treatment. Only thrombocytopenia and multiple pregnancy were independently associated with prostaglandin failure.