(858) Association of postpartum hemorrhage management with risks of hysterectomy, ICU admission, and severe maternal morbidity

Friday, January 31, 2025

10:30 AM – 12:30 PM

Submitting Author and Presenting Author(s)

Moeun Son, MD, MSCI (she/her/hers)

Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology
Weill Cornell Medicine
New York, NY, United States

Coauthor(s)

JC

Jennifer F. Culhane, MPH, PhD (she/her/hers)

Associate Research Scientist
Yale School of Medicine
New Haven, Connecticut, United States
EM

Evan Miller, BS, MS

Nemours Children's Hospital
Wilmington, Delaware, United States
SH

Sara Handley, MD, MSCE

Children's Hospital of Pennsylvania
Philadelphia, Pennsylvania, United States
HB

Heather Burris, MD, MPH

Attending neonatologist and Associate Professor of Pediatrics
Children's Hospital of Philadelphia
Philadelphia, Pennsylvania, United States
JG

Jay Greenspan, MD

Nemours Children's Hospital
Wilmington, Delaware, United States
Kathryn M. McKenney, MD (she/her/hers)

Assistant Professor
University of Colorado
Denver, Colorado, United States
LK

Lindsey Knake, MD

University of Iowa
Iowa City, Iowa, United States
RW

Robert Whetsel, PhD

US Food and Drug Administration
Silver Spring, Maryland, United States
KB

Kristie Baisden, MD

US Food and Drug Administration
Silver Spring, Maryland, United States
LB

Leah Berhane, MD, MHA

US Food and Drug Administration
Silver Spring, Maryland, United States
KD

Kevin Dysart, MD

Nemours Children's Hospital
Wilmington, Delaware, United States

Objective: To examine if varying management strategies of postpartum hemorrhage (PPH) is associated with hysterectomy, intensive care unit (ICU) admission, and severe maternal morbidity (SMM).

Study Design: This retrospective cross-sectional study utilized Epic Systems’ Cosmos research platform, a US-based electronic health record database with de-identified patient-level data. Individuals with an inpatient birth, PPH ICD-10-CM code, and PPH treatment from 1/1/17-12/31/23, without a placenta accreta spectrum ICD-10-CM code were included. Management strategies were categorized into 4 groups: “less aggressive medication use only” (2 types with < 2 doses of either or 1 type with < 3 doses); “more aggressive medication use only” (3 types, 2 types with ≥2 doses of either, or 1 type with ≥3 doses; “less aggressive medication plus procedure(s)”; and “more aggressive medication plus procedure(s)”. Medications included carboprost, methylergonovine, and tranexamic acid. Procedures included insertion of intrauterine device, curettage, and uterine artery embolization. Outcomes were hysterectomy, ICU admission, and SMM with and without transfusion during the birth encounter. Bivariable and multivariable logistic regression analyses were performed.

Results:

Of 277,585 patients treated for PPH, 84.9% received less aggressive medication use only (Table). There were 1,951 (7 per 1,000) hysterectomies, 6,383 (2.3%) ICU admissions, and 18,474 (6.7%) SMM cases without and 45,238 (16.3%) with transfusion. Patients with PPH procedures regardless of medication use, were more likely to undergo hysterectomy and experience SMM than those with less aggressive medication use only. Compared to patients with less aggressive medication use only, those with aggressive medication use only were significantly less likely to experience SMM without transfusion.

Conclusion:

Higher odds of hysterectomy and morbidity among patients with PPH procedures could represent delay in definitive treatment or confounding by indication (more severe PPH cases). Either way, these procedures are markers of increased risk for hysterectomy, ICU admission, and SMM.