Understanding the Disparities in Postpartum Hemorrhage and Hemorrhage Outcomes

Childbirth is the most common reason for hospital admission in the United States (U.S.). Maternal morbidity and mortality have been increasing. Significant racial and ethnic disparities have been demonstrated for both maternal morbidity and mortality. Postpartum hemorrhage (PPH) is one of the leading causes of maternal morbidity and mortality in the US. Minority women are more likely to hemorrhage, and experience worse PPH-related outcomes than non-minority white women. The morbidity and mortality related to PPH likely reflects the quality of the clinical response, as early recognition and prompt management of hemorrhage are critical to improving maternal outcomes. Yet, it is unknown whether minority women are more likely to have severe PPH due to differences in underlying risk factors or whether PPH is recognized and/or managed differently for minority women. Previous studies that have explored racial/ethnic disparities in PPH outcomes have used state or national datasets, which lack granular patient-level contributors as well as information on provider management. Northwestern University’s Prentice Women’s Hospital delivers approximately 12,000 women annually and the population is racially/ethnically diverse. A standardized form, available in the electronic health record (EHR), is completed for all women who experience a PPH. This form documents provider- and system-level activities at any given time, thus allowing for investigation of the sources of racial/ethnic disparities. We propose to use data from the EHR (2007-2017) to achieve the following aims: (1) To evaluate whether risk factors for PPH differ by race/ethnicity; (2) To identify racial/ethnic differences in PPH management (e.g. medications administered, blood transfused, surgical interventions used) and the timing of those interventions (e.g., time from PPH recognition to administration of additional uterotonics, time to transfusion); and (3) To develop a PPH prediction score that accounts for risk factors and patient race/ethnicity. This study will fill an important gap in the knowledge and understanding of patient-, provider-, and systems-level contributors to PPH and its related outcomes. This project will meet the mission of the National Institute of Minority Health and Health Disparities by furthering our understanding of contributors to disparities in PPH outcomes.