(578) The association of race and ethnicity with postpartum hemorrhage care escalation

We aimed to evaluate whether there were racial and ethnic disparities in postpartum hemorrhage (PPH) care escalation after cesarean birth in a large, diverse cohort of birthing people.

Study Design:

Secondary analysis of a multicenter placebo-controlled randomized trial of prophylactic use of tranexamic acid during cesarean birth. We included participants who self-reported as non-Hispanic White (NHW), non-Hispanic Black (NHB), or Hispanic and who had a PPH (estimated blood loss [EBL] > 1L). Based on a published algorithm for classifying PPH management, the primary outcome was level of PPH care intervention during the delivery admission: Level 0 (no intervention beyond standard third stage oxytocin), Level 1 (uterotonics only), Level 2 (performance of a procedure), and Level 3 (hysterectomy). We created multivariable ordinal regression models to evaluate the independent association between race/ethnicity and receipt of higher levels of anti-hemorrhagic intervention. A secondary analysis stratified these results by PPH severity.

Results:

Of 656 individuals who met inclusion criteria, 37% identified as NHW, 27% as NHB, and 36% as Hispanic. A majority received no interventions, with 360 (55%) Level 0, 154 (23%) Level 1, 118 (18%) Level 2, and 24 (4%) Level 3. NHB patients had a lower pre-delivery hemoglobin (10.9 mg/dL NHB vs. 11.7 NHW vs. 11.8 Hispanic, p< 0.01). In adjusted analyses, NHB patients had lower odds of receiving higher levels of PPH care compared to NHW patients (aOR 0.48, 95% CI 0.31-0.75, Table 1). As a proportion of Level 1 interventions, NHB patients received methylergonovine less often (9.0% NHB vs. 29.6% NHW vs. 30.3% Hispanic, p< 0.01). When stratified by severity of PPH, NHB patients had significantly lower odds of receiving higher levels of PPH care at an EBL between 1500-1999mL (aOR 0.32, 95% CI 0.14-0.78, Table 2).

Conclusion:

NHB patients with PPH after cesarean birth had 50% lower odds of receiving higher levels of anti-hemorrhagic intervention and this finding persisted at higher EBL. Racial differences in PPH care escalation may underlie disparities in PPH outcomes.