(140) Implementation of a standardized protocol for postpartum anemia: a prospective cohort study

Objective: Implementation of standardized protocols for antepartum anemia management increases utilization of intravenous iron (IVFe) and improves pre-delivery hemoglobin (Hb). However, anemia is often inadequately treated postpartum. We aimed to determine if implementation of a standardized protocol for postpartum anemia management improves postpartum IVFe utilization, as well as clinical outcomes.

Study Design: We performed a prospective cohort study evaluating implementation of a standardized protocol for postpartum anemia management into inpatient care. This protocol, implemented in December 2021, recommends (1) IVFe for postpartum Hb 7.0-8.9 g/dL and (2) oral iron (IVFe if intolerant) for postpartum Hb 9.0-9.9 g/dL (or admission Hb < 11.0 g/dL without known postpartum Hb). We compared all postpartum inpatients at a single site in April 2021 (PRE) to April 2022 (POST). The primary outcome was IVFe use during postpartum stay. Secondary outcomes included number of IVFe doses, oral iron supplementation at discharge, postpartum complications, and postpartum length of stay. Sensitivity analysis was performed only for those qualifying for IVFe based on the protocol.

Results: 805 patients were included (PRE=401; POST=404). Patients in the PRE and POST group differed in self-reported race (PRE: 44.0% Black, Indigenous, People of Color [BIPOC] vs. POST: 50.1% BIPOC, p=0.07) and ethnicity (PRE: 8.2% Hispanic vs. POST: 14.9% Hispanic, p=0.003). Utilization of IVFe significantly improved from PRE to POST-implementation (6.0% vs. 11.1%, p=0.009) even when controlling for differences between groups (aOR 2.48, 95% CI [1.08-5.67]). Patients in the POST group received more doses of IVFe (p=0.04) and had shorter lengths of stay (p < 0.001; Table). There were no significant differences in oral iron supplementation at discharge or postpartum complications. When analyzing only patients who were eligible for IVFe, similar results were found.

Conclusion: Implementation of a standardized protocol for management of postpartum anemia improved IVFe utilization without increasing length of stay.