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Retroprospective Analysis of Risk Factors Associated with Severe Post Partum Hemorrhage Requiring Blood Transfusion
Abstract Number: F4A-6
Abstract Type: Original Research
Maternal hemorrhage is a leading cause of maternal mortality worldwide. Although the majority of patients that suffer from postpartum hemorrhage (PPH) have identifiable risk factors (1), data regarding risk factors for PPH patients requiring blood transfusion are lacking in the literature. By reviewing the transfusion data for a single institution hospital from 2012-2014, our aim was to develop a matrix to assess which parturient are likely to have severe PPH requiring blood transfusion based on known risk factors.
This retrospective study used blood product transfusion data supplied by the blood bank for all parturient requiring transfusion as part of their peripartum hospital course at a single institution from 2012 to 2014. A risk factor matrix for postpartum hemorrhage based on demographic and obstetric data was created by a panel of experts and used to collect data on each patient from the electronic medical record. The matrix was stratified by mode of delivery: vaginal delivery, cesarean delivery without labor, and cesarean delivery after trial of labor. Descriptive statistics were used to analyze risk factors for transfusion within each group of patients.
A total of 298 patients received blood products between 2012 and 2014 during their peripartum period. 15 patients that received blood products were excluded from analysis because they did not have post partum hemorrhage. Of the remaining 283 patients, 97 delivered vaginally (with and without instrumentation), 110 received a caesarean delivery without a trial of labor, and 76 received a caesarean delivery after a trial of labor. Some of the most common risk factors identified include chorioamionitis, magnesium infusion, and multiple gestation (Table 1A). However, the most common risk factor differed from group to group (see Table 1B).
The largest group of patients needing blood transfusion was the group undergoing a caesarean delivery without undergoing labor. Vaginal deliveries were least likely to require blood transfusions. This is in line with the ACOG initiative to decrease the number of caesarean deliveries. The differences in common risk factors for each mode of delivery shows nuances in predicting severe PPH. These nuances should be further explored to improve current PPH guidelines, and ultimately outcomes.
1: ACOG Committee on Practice Bulletins. 2017 183.