Racial Disparities in Postpartum Hemorrhage in a Community Hospital: A Retrospective Cohort Analysis [24C

Abstract

INTRODUCTION: Nationwide Inpatient Sample data from 2012–2014 shows significantly higher risks for postpartum hemorrhage (PPH) for black women. As accumulating evidence raises the question about racial disparities in obstetric outcomes, we aimed to assess disparities in the prevalence of PPH at our community healthcare system. METHODS: This retrospective cohort study included deliveries at one of Main Line Health System's four acute care hospitals between May 1st, 2018 and May 1st, 2019. PPH was defined as a cumulative estimated blood loss (EBL) of greater than or equal to 1,000 milliliters. The primary outcome was incidence of PPH among racial groups (white, black, Asian, other). Multivariable logistic regression was used to assess the relationship between race and PPH, while controlling for age, ethnicity, gestational age, multiple gestations, gravidity, parity, obesity complicating pregnancy, chronic and pregnancy-related hypertensive disorders, and gestational diabetes. RESULTS: 6,517 deliveries from 6,390 mothers were analyzed. 74% of mothers identified as white, 15% black, 8% Asian, and 3% other. Compared to white and Asian mothers, black mothers were significantly younger and had higher rates of obesity complicating pregnancy, chronic hypertension, and having a cesarean section. The rate of PPH was significantly higher in black mothers (9.7%) compared to white (6.2%) and Asian (4.4%) mothers (P<.001). After controlling for delivery characteristics, the odds of black mother's having PPH was 1.96 and 2.46 times greater than white and Asian mothers, respectively. CONCLUSION: Even after controlling for risk factors associated with PPH, black mothers at our community hospital are nearly 2 times more likely to experience hemorrhage.