(749) Time from decision to execution of manual exploration of the uterus and postpartum hemoglobin drop

Manual exploration of the uterus is performed in women with postpartum hemorrhage to remove blood clots, retained placenta and to repair obstetrical tears. There is very limited data to evaluate the time from when the decision of conducting the manual exploration is made to the actual procedure to avoid complications.

Study Design:

A retrospective cohort study conducted between 2013 and 2019. The data was collected from women in the maternity ward who underwent a manual exploration of the uterus after a vaginal birth. A comparison was made between women in whom the time from making the decision of performing manual exploration to the time of the procedure was more than 20 minutes ( >20 minutes cohort) versus up to 20 minutes (≤20 minutes cohort). The primary outcome was the rate of women with hemoglobin (Hb) decrease of at least 3 g/dL after delivery.

Results:

Among 696 women who were analyzed, 224 and 472 women underwent manual exploration >20 minutes and ≤20 minutes, respectively. Characteristics and outcomes are presented in tables 1 and 2. Mean time from decision to performing manual exploration was 45±54.8 and 9.5±5.6 minutes in the >20 minutes and ≤20 minutes cohorts, respectively (P < .0001). Mean Hb decrease was greater in the >20 minutes cohort versus ≤20 minutes cohort (3.4 ±1.7 gr\dl versus 1.8±3.0   gr\dl, respectively; P=0.02). The rate of Hb decrease≥3 g/dL was 59% and 50% in the >20 minutes and ≤20 minutes cohorts, respectively (P=0.06). No other significant differences were observed. The cutoff for performing manual exploration to predict Hb decrease of at least 3 g/dL was 19 minutes (47% sensitivity, 54% specificity)

Conclusion: While it seems that the medical staff is skilled in managing the optimal time to perform manual exploration of the uterus, the time from decision to procedure should be up to 20 minutes in order to avoid excessive blood loss.