(1027) Time to transfusion following implementation of quantitative blood loss protocol

Postpartum hemorrhage (PPH) is a leading cause of maternal morbidity and mortality. PPH bundles that include quantitative blood loss (QBL) assessment are recommended for prevention, identification, and treatment of hemorrhage. Data regarding the clinical utility of QBL assessment are mixed. We compared time from delivery to transfusion before and after implementation of a QBL protocol.


Study Design:

This is a retrospective cohort study of patients who delivered between December 2013 to December 2019, excluding a washout period from 2017-2018 during QBL implementation. Pre-QBL and post-QBL groups were compared. All live births were included. Data were extracted from maternal electronic medical records. Transfusion was defined as postpartum administration of packed red blood cells during delivery hospitalization. Primary outcome was hours from time of delivery to time of transfusion order. Secondary outcomes were frequency of PPH, transfusion, and mean number of units transfused. Logistic regression was used to control for mode of delivery and PPH risk assessment upon admission.


Results:

There were 4722 and 6391 deliveries included in the pre -QBL and post-QBL groups, respectively.  The post-QBL cohort had a higher frequency of vaginal delivery (63.2% vs 60.9%, p = 0.027) with lower proportion classified as high risk for PPH (3.9% vs 5.5%, p < 0.001, Table 1). Mean blood loss decreased from 545.5 mL to 452.9 mL. Median times to transfusion decreased from 20.5 to 12.5 hours (p < 0.018). PPH decreased following implementation (7% vs 12%, aOR 0.55, 95% CI 0.48-0.63), as did frequency of transfusion (1.7% vs 2.6%, aOR 0.67, 95% CI 0.52-0.87). Mean units transfused also decreased following QBL implementation (p < 0.001).


Conclusion:

Implementation of QBL assessment did shorten the time to transfusion, and was associated with decreased risk for PPH, frequency of transfusion, and mean units transfused.