PB1393 - Clinical timing of uterotonic medications, tranexamic acid (TXA), and blood transfusions in postpartum hemorrhage (PPH) management

Background: PPH is the cause of 11% of maternal deaths in the United States. Studies examining optimum timing of medications for hemorrhage management/prevention and period of highest risk after delivery are limited.

Aims: To describe the patterns of clinical timing for use of uterotonics (misoprostol, methergine, carboprost), TXA, and transfusions in the management of postpartum hemorrhage in the obstetric population.

Methods: Patients who delivered at the George Washington University Hospital from July 2019 to May 2021 with a quantitative blood loss (QBL) greater than or equal to 1000 mL were identified. Delivery time, QBL, methods of interventions were analyzed, including administration of uterotonics (misoprostol, methergine, carboprost), TXA, transfusions, and other surgical interventions.

Results: We included n=463 PPH patients of which 102 (22%) received carboprost, 170 (37%) received methergine, 143 (31%) received misoprostol, 141 (30%) received TXA, and 111 (24%) received transfusions. 2 patients underwent a hysterectomy ( < 1%), and 7 (1%) patients required uterine artery embolization.
411 (89%) patients were given the PPH diagnosis within an hour of delivery with 170 (37%) patients sub-typed as intraoperative/intrapartum PPH, defined as ≥1000 mL QBL within the immediate delivery period, and the remaining 241 (52%) sub-typed as ≤1 hour postpartum. The remaining 52 (11%) patients were diagnosed after 1 hr with the latest diagnosis at 22.3 hours postpartum. Figure 2 demonstrates that there was no correlation between QBL and time to PPH diagnosis (r-squared= 0.011).

Conclusion(s): The majority of PPH patients were diagnosed within 1 hour postpartum, however, QBL was not correlated with the time elapsed to PPH diagnosis. Additional analyses plan to examine time to administration of the first agent, time to transfusion and any racial/ethnicity interactions and correlation of degree of pre-existing anemia and PPH diagnosis.