(1095) Incidence of postpartum hemorrhage by quantitative blood loss at delivery compared to ACOG reVITALize criteria

Friday, February 10, 2023

3:30 PM – 5:00 PM

Objective: Postpartum hemorrhage (PPH) is defined by ACOG’s reVITALize program as cumulative blood loss ≥1000ml or with signs and symptoms of hypovolemia within 24 hours of delivery. However, many institutions still base rates of PPH by blood loss at time of delivery only. We sought to evaluate the PPH rate using reVITALize criteria versus by quantitative blood loss (QBL) at time of delivery. The secondary objective was to stratify these outcomes by BMI class.

Study Design: A single-institution, retrospective cohort study was conducted on all patients who delivered between August 2020 and August 2021. Inclusion criteria included QBL ≥1000ml within 24 hours of vaginal or cesarean delivery and age ≥18 years old. Patients were stratified into the following BMI categories: non-obese ( < 30kg/m²), class I obesity (≥30-34.9 kg/m²), class II obesity (≥35-39.9 kg/m²), and class III obesity (≥40 kg/m²). The primary outcome was patients who did not have a PPH at time of delivery but met reVITALize criteria for PPH within 24 hours of delivery.

Results: Of the 3103 patients who delivered at our institution during the study timeframe, 394 (12.7%) experienced a PPH defined by reVITALize criteria. There were 119 non-obese patients, 118 patients with class I obesity, 70 patients with class II obesity, and 87 patients with class III obesity. All demographic data were similar between groups (Table). At time of delivery, 311 (10%) patients had QBL ≥1000ml. Of the remaining 83 (2.7%) patients with QBL < 1000ml at time of delivery, but ultimately met criteria for PPH within 24 hours of delivery, 23.5% were non-obese, 28.3%, 17.1%, and 19.5% were class I, class II and class III obese, respectively. There were no significant differences in incidence of PPH patients who had an initial QBL < 1000ml at time of delivery across BMI categories (Figure).

Conclusion: Adherence to reVITALize criteria increases PPH rates at a single institution from 10% to 12.7% without any difference between obese and non-obese patients. It is critical to monitor bleeding for 24 hours postpartum to accurately reflect rates of PPH.

Presenting Author(s)

Michaela Y. Lee, MA (she/her/hers)
University of Texas Health Science Center at San Antonio
San Antonio, Texas, United States

Coauthor(s)

Claire D. Sundjaja, BSA (she/her/hers)
University of Texas Health Science Center at San Antonio
San Antonio, Texas, United States

Primary Author(s)

CeCe Cheng, MD (she/her/hers)
MFM Fellow
University of Texas Health Science Center at San Antonio
San Antonio, Texas, United States

Coauthor(s)

B. Kate Neuhoff, MD
MFM Fellow
University of Texas Health Sciences Center at San Antonio
San Antonio, Texas, United States
BM
Bryce T. Munter, MD, MS
University of Texas Health Science Center at San Antonio
San Antonio, Texas, United States
JB
John J. Byrne, MD, MPH
Physician
UT Health Sciences Center at San Antonio
San Antonio, Texas, United States