Abstract
In randomized trials, antepartum intravenous iron sucrose (IVFe) is effective at improving pre-delivery Hemoglobin (Hb). Yet, there is a gap between this knowledge and implementation into care. We aimed to determine if implementation of a standardized protocol for management of antepartum anemia in the real-world improves IVFe utilization, as well as clinical outcomes. We performed a prospective cohort study evaluating incorporation of an anemia protocol into care. Our protocol, developed with multidisciplinary stakeholders, included (1) serial 3rd trimester Hb assessment (2) oral iron supplementation for antepartum Hb 9.5-11g/dL and (3) IVFe use (300mg weekly/3 weeks) for persistent Hb<9.5g/dL. We compared a 6-months Pre-implementation (1/2018-6/2018) to 6-months Post-implementation (1/2019-6/2019). Women with an antepartum Hb <11.0g/dL were included in this analysis. Outcomes evaluated: IVFe utilization, number of IVFe doses, pre-delivery Hb, and blood transfusion. 1455 women were included (Pre=792;Post=663) without significant baseline differences. Antepartum Hb nadir was no different between groups (Pre:10.2[9.6-10.6] vs. Post:10.2[9.6-10.6], p=0.67; Table). IVFe was administered to 23.6% of women with antepartum Hb<9.5g/dL in the Pre-implementation group compared to 41.7% Post-implementation (OR 1.79 95%CI [1.17-2.75]). Of the patients who received IVFe, more women in the Post-implementation received at least 3 IVFe doses (Pre:23.7% vs. Post:47.3%, p=0.02). Pre-delivery Hb significantly increased from Pre- to Post-implementation (Pre:10.9[10.1-11.6] vs. Post:11.0[10.3-11.7] p=0.03). There was a non-significant difference in blood transfusion between groups (Pre:7.1% vs. Post:5.0%, p=0.10). Implementation of a standardized antepartum anemia protocol is associated with increased IVFe utilization and an improvement in pre-delivery hemoglobin. Implementation strategies are needed to increase protocol adherence with the goal of a clinically significant reduction in blood product administration and morbidity at delivery.
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