(628) Risk Factors for Extended ICU stays in the setting of Postpartum Hemorrhage

Objective: Patients with postpartum hemorrhage have higher rates of admission to the ICU compared to most pregnant persons. However, not much is known about risk factors that preclude extended ICU admission in these patients.

Study Design: This was a retrospective cohort study of singleton non-anomalous pregnancies delivered between 23 and 42 weeks from 2007-2012 in California. Pregnancies were further stratified by any maternal admission to the ICU. We examined those whose pregnancy had additionally been complicated by postpartum hemorrhage (PPH). An extended ICU admission was categorized using overall Length of Stay (LOS) greater than the median number of days spent by a patient in the ICU in the setting of PPH. A multivariate logistic regression was used to evaluate increased odds of extended ICU admission adjusted by maternal race/ethnicity, maternal age, pre-pregnancy BMI, education level, insurance status, smoking status, prenatal care, chronic hypertension, and pre-existing diabetes.

Results: Of the 2,747,441 pregnant persons in our original cohort, 1,972 pregnant persons had an ICU admission over the course of their pregnancy. 786 of these pregnancies were in the setting of PPH, with 449 having a stay greater than 5 days, the median length of stay in patients with PPH. Patients who were over the age of 35 had increased odds of an extended ICU admission (aOR 1.81 95%CI 1.27-2.05). No other factors measured had any significant impact on rates of extended ICU admission.

Conclusion: Patients above the age of 35 have increased risk of an extended ICU admission in the setting of PPH. However, several other sociodemographic factors commonly thought to be associated with negative maternal outcomes showed no impact. Further studies should focus on these associations in order to counsel patients effectively.