(418) Incidence of severe maternal morbidity in obese patients with postpartum hemorrhage

Thursday, February 9, 2023

4:00 PM – 5:30 PM

Objective: Increasing body mass index (BMI) has been shown to be associated with increased incidence of pregnancy-associated morbidity and mortality, including postpartum hemorrhage (PPH). We sought to compare the incidence of severe maternal morbidity (SMM) among non-obese and obese patients who experienced PPH.

Study Design: We conducted a retrospective cohort study of all patients delivering at our tertiary care from 08/2022-08/2021. Inclusion criteria included quantitative blood ≥1000ml within 24 hours of vaginal delivery 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 a composite of Centers for Disease Control and Prevention (CDC) SMM criteria. The secondary outcome was a composite of hemorrhage-related SMM criteria defined as blood transfusion ≥4 units, hemorrhagic shock, acute kidney injury, transfusion-related acute lung injury, cardiac arrest, and the use of interventional radiology procedures.

Results: During the study timeframe, 394 patients experienced a PPH. There were 119 (30.2%) non-obese patients, 118 (30%) patients with class I obesity, 70 (22.8%) patients with class II obesity, and 87 (22%) patients with class III obesity. All demographic characteristics were similar between groups. Within the non-obese, class I, class II and class III obese categories, 18 (9.2%), 8 (6.8%), 7 (10%), and 8 (9.2%) patients met CDC-defined SMM criteria, respectively, with a significant difference seen between patients who were non-obese and those with class I obesity (p=0.04, Figure 1). There were no significant differences across BMI categories for hemorrhage-related SMM (Figure 2).

Conclusion: Obese patients who experienced PPH have similar rates of overall SMM and hemorrhage-related SMM compared to their non-obese counterparts. The higher incidence of CDC-defined SMM in non-obese patients compared to class I obese patients is likely due to the small number of patients meeting SMM criteria overall.

Presenting Author(s)

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

Coauthor(s)

Michaela Y. Lee, MA (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