Poster Session 3
Rachel L. Wiley, MD, MPH (she/her/hers)
MFM Fellow
University of California, San Diego
San Diego, California, United States
Ipsita Ghose, MD
Baylor College of Medicine
Houston, Texas, United States
Hector M. Mendez-Figueroa, MD
Associate Professor
McGovern Medical School at UTHealth
Houston, Texas, United States
Suneet P. Chauhan, MD
Director of MFM Research
Delaware Center of Maternal-Fetal Medicine at Christiana Care
Delaware, Delaware, United States
Use of uterotonics beyond prophylactic ranges from 2-25%, while postpartum hemorrhage (PPH; blood loss > 1000 mL) ranges from 3-5%. We examined factors in individuals without PPH who received additional uterotonics versus those who did not.
Study Design:
This retrospective cohort included all singleton live births > 22 weeks with 24-hour blood loss < 1000 mL at a Level IV center over 24 months. Clinical and demographic elements were abstracted by medical staff, and additional uterotonic use was defined as any agent utilized after prophylactic oxytocin, including additional doses of oxytocin, misoprostol, methylergonovine, tranexamic acid or carboprost. Individuals were stratified by route of delivery and examined by students' t-test and chi-square.
Results:
Of 8,623 deliveries, 7,616 (88%) were included with 4,369 (57.4%) vaginal deliveries (VD) and 3,247 (42.6%) cesarean deliveries (CD). VD without PPH was significantly more likely to receive additional uterotonics compared to CD (14% vs. 11%, p< 0.001). The average blood loss was higher with vs. without uterotonics (398 ± 211.24 mL vs 241 ± 149.92 mL, p< 0.001 for VD; 700 ± 135.43 mL vs 633 ± 129.62 mL, p< 0.001 for CD). While some pre-existing characteristics differed, they were inconsistent across routes except for BMI, hypertensive disorders, low platelets, magnesium sulfate and oxytocin use (Table 1 & 2). There were no significant differences in provider characteristics. PPH risk stratification was only different in VD. Deliveries without PPH who received additional uterotonics were more likely to be transfused, receive additional surgical intervention and be admitted to intensive care (Table 2).
Conclusion:
About 1 in 10 deliveries without PPH received uterotonics beyond prophylactic. No risk factors or patient characteristic predicted this behavior. Blood loss and interventions were increased with additional uterotonics, suggesting clinicians may be pre-emptively treating clinical concern rather than risk factors. Additional exploration into risks, benefits, and threshold of early intervention with uterotonics is warranted.
