Obstetric Hemorrhage Management and Maternal Morbidity Among Non-Hispanic Black Women [34L]

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Abstract

INTRODUCTION:

Non-Hispanic Black women (NHB) have higher rates of severe maternal morbidity and mortality. We sought to evaluate the racial differences in maternal hemorrhage management and associated morbidity.

METHODS:

We conducted a retrospective cohort study including all women who delivered at a tertiary center during February 1, 2013–December 31, 2014. Medical charts were reviewed for hemorrhage, race/ethnicity and relevant clinical data. Hemorrhage related severe morbidity indicators included blood transfusion, shock, acute renal failure, transfusion related lung injury, cardiac arrest and use of interventional radiology procedures. The data was analyzed using χ2, student t-test, Mann Whitney U test, and logistic regression where appropriate. P<.05 was considered significant.

RESULTS:

There were 9,890 deliveries and 2.9% were complicated by obstetric hemorrhage. NHB women when compared to other women with obstetric hemorrhage had a lower admission hemoglobin (10.6±1.6 versus 11.5±1.3 g/dL, P<.001), lower drop in hemoglobin (2.4±1.5 versus 2.9±1.6 g/dL, P=.03) and higher blood loss (1,328±1,014 versus 1,113±602 mL, P<.001). They were equally likely to be treated with uterotonic medications. There was no difference in the time to initiate medication and time to stabilization but NHB were more likely to need a blood transfusion (37.1% versus 23%, P=.03) and more likely to have severe morbidity (41.4% versus 24.4%, P=.001). After controlling for confounding variables, cesarean delivery (aOR 3.59 [1.7–7.9]) and low admission hemoglobin (aOR 1.69 [1.3–2.1]) were predictors of severe morbidity.

CONCLUSION:

Despite similar management, NHB had more maternal morbidity. However, cesarean delivery and low admission hemoglobin but not race were predictive of maternal morbidity.

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