967 Maternal race and postpartum hemorrhage in women with a prior postpartum hemorrhage

Abstract

Previous studies have shown race as a significant risk factor for postpartum hemorrhage (PPH), but the association of race and PPH during the second delivery has not been investigated. The objective of this study was to see if there was an association between race and PPH during the second delivery in women with a PPH during their first delivery. This is a retrospective study of women who had their first two deliveries in California (2000-2011). We further restricted the data for all women who presented with PPH during their noted first delivery (2000-2011) and had second delivery with singletons, non-anomalous, 23-42 weeks gestational age babies between the duration of 2007-2011. Exclusion criteria were multiple babies, anomalies, gestational age42 weeks, and missing race/ethnicity of women during second deliveries. PPH was identified using ICD-9 diagnosis codes (666.0-666.2). Demographics were compared using chi-square tests. Multivariable logistic regression models were used to examine the association between race and PPH during second delivery. In this study, 5260 women had PPH during their first delivery and delivered their second baby between 2007 and 2011. Of these, 8.4% had PPH during second delivery. Multivariable logistic regression results showed that Non-Hispanic Black (aOR=1.75, 95% CI: 1.07-2.87), Hispanic (aOR=1.72; 95% CI: 1.27-2.33), Asian (aOR=2.27; 95% CI: 1.58-3.26), and Native American (aOR=1.82 (95% CI: 0.62-5.37) women had higher odds of PPH at second delivery as compared to Non-Hispanic White women, after controlling for age, education, body mass index, insurance, smoking, inter-pregnancy interval, mode of delivery (first and second birth) and birthweight at second birth. Non-Hispanic Black, Hispanic, and Asian women exhibited significantly higher odds of PPH during the second delivery as compared to White women. There may be differences in care management or biologic factors that influence postpartum hemorrhage in these populations.