Department of Gynecology and Obstetrics, The Johns Hopkins University School of Medicine, Baltimore, MD (Mses Guan and Boyer and Drs Darwin, Henshaw, Lawson, and Vaught).
Division of Cardiology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD (Dr Michos).
Am J Obstet Gynecol MFM. 2023 Jun;5(6):100938. doi: 10.1016/j.ajogmf.2023.100938. Epub 2023 Mar 21.
Postpartum hemorrhage is a leading cause of maternal morbidity and mortality in the United States and disproportionately affects pregnant persons of color.
This study aimed to identify the demographic and obstetrical characteristics of those who received different levels of antihemorrhagic intervention in the setting of severe postpartum hemorrhage requiring blood transfusion.
This was a retrospective cohort study of patients with documented postpartum hemorrhage (estimated blood loss of ≥1000 mL) and blood product transfusion. Moreover, 3 levels of antihemorrhagic intervention were defined as follows: level 1, administration of uterotonics only; level 2, performance of a procedure (ie, B-Lynch suture, O'Leary stitch, Bakri balloon, dilation and curettage, laceration repair, or embolization); and level 3, hysterectomy. Maternal demographics, obstetrical characteristics, and comorbidities were extracted from electronic health records. Ordinal logistic regression was used to estimate the odds of higher intervention levels adjusting for maternal demographic and obstetrical characteristics.
Of note, 365 patients were included in this study, with a racial or ethnic composition of 30% White, 42% Black, 18% Hispanic, and 10% other. Moreover, 233 patients (64%) received level 1 intervention, 98 patients (27%) received level 2 intervention, and 34 patients (9%) received level 3 intervention. Patients receiving higher levels of intervention were more likely to have greater estimated blood loss (P<.001), have more transfusions (P<.001), and be of advanced maternal age (P=.004). Black and Hispanic patients were less likely to have received higher levels of intervention than White patients (P=.034). After adjusting for estimated blood loss, advanced maternal age, placenta accreta spectrum, and fibroids, Black patients remained significantly less likely to receive higher levels of intervention (adjusted odds ratio, 0.55; 95% confidence interval, 0.30-0.98). This difference persisted at an estimated blood loss of ≥3000 mL, with Black and Hispanic patients being significantly less likely to receive higher levels of intervention than White patients (odds ratio, 0.31 [95% confidence interval, 0.10-0.92] and 0.10 [95% confidence interval, 0.01-0.53], respectively).
Among patients experiencing postpartum hemorrhage and receiving transfusion, Black patients are less likely to receive higher levels of antihemorrhagic intervention. This disparity is concerning in this high-risk population and requires further attention and investigation.
产后出血是美国产妇发病率和死亡率的主要原因，并且不成比例地影响有色人种的孕妇。
本研究旨在确定在需要输血的严重产后出血情况下接受不同水平抗出血干预的人群的人口统计学和产科特征。
这是一项回顾性队列研究，纳入了有记录的产后出血（估计失血量≥1000 毫升）和血制品输注的患者。此外，将 3 个抗出血干预水平定义如下：1 级，仅给予宫缩剂；2 级，进行手术（即 B-Lynch 缝合术、O'Leary 缝合术、Bakri 球囊、刮宫术、裂伤修复术或栓塞术）；3 级，子宫切除术。从电子病历中提取产妇人口统计学、产科特征和合并症。使用有序逻辑回归估计调整产妇人口统计学和产科特征后更高干预水平的可能性。
值得注意的是，本研究纳入了 365 名患者，其种族或民族构成分别为 30%的白人、42%的黑人、18%的西班牙裔和 10%的其他种族。此外，233 名患者（64%）接受了 1 级干预，98 名患者（27%）接受了 2 级干预，34 名患者（9%）接受了 3 级干预。接受更高水平干预的患者更有可能出现更大的估计失血量（P<.001）、更多的输血（P<.001）和更年长的产妇年龄（P=.004）。黑人患者和西班牙裔患者接受更高水平干预的可能性低于白人患者（P=.034）。在调整估计失血量、产妇年龄、胎盘植入谱系和肌瘤后，黑人患者接受更高水平干预的可能性仍然显著较低（调整后的优势比，0.55；95%置信区间，0.30-0.98）。在估计失血量≥3000 毫升时，这种差异仍然存在，黑人患者和西班牙裔患者接受更高水平干预的可能性显著低于白人患者（优势比，0.31[95%置信区间，0.10-0.92]和 0.10[95%置信区间，0.01-0.53]）。
在经历产后出血并接受输血的患者中，黑人患者接受更高水平抗出血干预的可能性较低。在这个高危人群中，这种差异令人担忧，需要进一步关注和调查。
