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Obstetric Interventions and Maternal Morbidity among Women who experience Severe Postpartum Hemorrhage during Intrapartum Cesarean Delivery
Abstract Number: T-23
Abstract Type: Original Research
Women who undergo intrapartum Cesarean delivery (CD) are at the highest risk for postpartum hemorrhage (PPH) compared to those undergoing prelabor CD or vaginal delivery.(1,2) Rates of hemorrhage-related morbidity among women who experience severe PPH during intrapartum CD are uncertain. We performed a retrospective study to assess rates of medical/surgical intervention and transfusion among women undergoing intrapartum CD.
We performed a secondary analysis of data from a cohort of women who experienced severe PPH during intrapartum CD at a tertiary US obstetric center from 2002-2012. Inclusion criteria were women undergoing cesarean delivery with prior active labor or induction of labor. Severe PPH was defined as an EBL≥1500ml &/or red blood cell (RBC) transfusion within 48 hr of delivery. Matched controls were identified (women with an EBL<1500 ml and no RBC transfusion). We compared rates of medical intervention (uterotonic use, bakri balloon, interventional radiology), surgical intervention (vessel ligation, hysterectomy) between women with severe PPH vs. controls. Transfusion data were analyzed in women with severe PPH. Data are presented as n (%), mean (SD), median [IQR]; P<0.05 as statistically significant.
We identified 278 women with severe PPH and 572 matched controls. The mean EBL values were significantly higher among women with severe PPH compared to controls (1685 (665) ml vs. 781 (202) ml; P<0.001). Medical/surgical interventions are presented in Table 1. Compared to controls, patients with severe PPH had a greater likelihood of requiring 2nd line uterotonics and medical/surgical intervention (excluding hypogastric artery ligation). Major morbidity among women with severe PPH included respiratory failure (6.1%) and renal failure (1%). Intraoperative and postoperative blood product utilization data are presented in Table 2. Among those with severe PPH, the rate of RBC transfusion was higher post-CD compared to during CD (43.9% vs. 18.3%; P=0.05).
Our findings suggest that, among women with severe PPH during intrapartum CD, second line uterotonic use is high and the B-lynch brace suture is the most common surgical intervention. With 10% patients requiring ICU admission post-PPH, cost-effectiveness studies are needed to determine the best environment for monitoring patients after an episode of severe PPH.
References: (1) BJOG 2008; 115: 1265-72 (2) Anesth Analg 2010;110:1368-73