(481) Postpartum hemorrhage requiring transfusion increases short-term risk of readmission for cardiovascular disease

Objective: Postpartum hemorrhage (PPH) is a common obstetric complication that, in severe cases, may necessitate blood transfusion. We hypothesized that severe PPH constitutes a cardiovascular insult that confers risk beyond the immediate postpartum period and that necessitating blood transfusion serves as a marker of the severity of PPH. Severe PPH may plausibly be linked to cardiovascular disease (CVD) by large-volume acute blood loss causing hypoperfusion and ischemia, leading to impaired cardiac function.

Study Design: We performed a retrospective cohort study of discharges from delivery hospitalizations in the United States, 2010-2020, using the Healthcare Cost and Utilization Project’s Nationwide Readmissions Database. ICD 9 and 10 coding were used to identify deliveries complicated by PPH with and without blood transfusion. Associations between PPH and non-fatal CVD readmissions within the calendar year following delivery were derived from Cox proportional hazard models expressed in confounder-adjusted hazard ratios (HR) with 95% confidence intervals (CI).

Results: Of 18,600,829 delivery admissions, 3.9% (n=752,891) were complicated by PPH. Of these, 13.7% (n=103,040) received a blood transfusion. The risk of CVD readmission was 170, 197, and 476 per 100,000 hospital deliveries for patients without PPH, PPH without transfusion, and PPH with transfusion, respectively. Compared to those without PPH, patients with PPH and no transfusion had an increased risk of CVD readmission (HR 1.19, CI 1.11-1.28), with more than a doubling of risk among patients with PPH with transfusion (HR 2.20, CI 1.97-2.47). The risks were highest after PPH with transfusion for atherosclerotic heart disease (HR 4.42, CI 3.04-6.42), ischemic heart disease (HR 2.79, CI 2.09-3.71), and acute myocardial infarction (HR 2.39, CI 1.58-3.63)(Figure 1).

Conclusion: PPH, particularly when requiring blood transfusion, is associated with an increased risk of non-fatal CVD readmission within the year following delivery. These findings underscore the burden of CVD risk with PPH and the need for active management to reduce CVD morbidity.