Healthcare burden associated with postpartum hemorrhage after cesarean delivery: a contemporary cohort

Abstract

Postpartum hemorrhage (PPH) is a leading cause of maternal morbidity and mortality and causes significant burden on the health care system. Our objective was to characterize factors associated with healthcare burden among pregnancies complicated with PPH after cesarean delivery using a contemporary cohort. Secondary analysis of the Tranexamic Acid (TXA) for the Prevention of Obstetrical Hemorrhage After Cesarean trial in which prophylactic TXA after cord clamping did not affect trial primary outcome, mortality or transfusion of PRBC. For this secondary analysis, PPH was defined as: EBL > 1000 or receipt of PRBCs in the first 48 hours postpartum (PP). The primary outcome was hospital readmission for ≥ 24 hours within 6 weeks PP or maternal death (a competing outcome). Secondary outcomes were: maternal length of stay after delivery, as well as ICU admission for ≥ 24 hours, thrombotic complications, and postpartum infectious complication within 6 weeks PP (e.g., endometritis, surgical site infection, pelvic abscess). Data was abstracted by trained research nurses. Univariable and multivariable analyses were performed to assess the association between PPH and the primary and secondary outcomes. From March 2018 through July 2021, 10,995 patients were enrolled in the TXA trial, and 9284 (84.4%) had data available for this analysis (950 with PPH and 8334 without). Several baseline characteristics differed between those with or without PPH (Table 1). All factors associated with increased healthcare burden occurred more often in those with PPH versus without PPH, and all, except the primary outcome of readmission for ≥ 24 hours within 6 weeks PP or maternal death, remained associated with PPH after adjusting for confounders (Table 2). PPH after cesarean delivery, defined by > 1 L or PRBC transfusion, is independly associated with a number of indicators of increased healthcare burden. In addition to preventing morbidity and mortality, averting PPH would have a significant effect on health care utilization and maternal burden.View Large Image Figure ViewerDownload Hi-res image Download (PPT)