ABSTRACTS
Factors Associated with the Prehospital Management of Postpartum HemorrhageAuthor: Monica Shannon, Shannon Gollnick, Ginny R. Kaplan, and Michael W. Hubble | | Associate Authors:
Introduction: Overall, 20% of women will experience postpartum hemorrhage (PPH) after childbirth, and PPH accounts for 11% of maternal deaths. Prehospital birth and maternal death rates are increasing nationwide, and literature suggests emergency medical services (EMS) management of PPH is inadequate. Objective: To determine the prehospital management of PPH. Methods: This was a retrospective analysis of potential cases of PPH using the 2020 ESO Research Data Collaborative. Cases were identified using any primary or secondary impression combination of obstetrical hemorrhage–related complaints. Variables significant in the univariate analysis were used to construct a logistic regression model of predictors of tranexamic acid (TXA) administration while controlling for potential confounders. An area under the curve of the receiver operating characteristic (AUCROC) was computed to determine model predictability. Results: Of the 1827 patients in the sample, 81 (4.4%) received TXA. The mean patient age was 39.8 ± 19.3 years; minorities accounted for 35.1% of the sample. Univariate analysis showed a significant difference in EMS response and transport times, total amount of IV-administered fluids, and prehospital shock index (all p < .001). African-American race was also significant, in that TXA was administered in nearly half as many patients (1.0% vs. 1.9%; p < .01); however, these results were nonsignificant in the multivariable analysis. The regression showed that receipt of TXA was 1% more likely with each year of increasing age (OR = 1.01, 95% CI = 1.00–1.02); 5.5 times more likely with each point increase in prehospital shock index (OR = 5.5, 95% CI = 3.1–9.77); and 2.3% less likely with each added minute of transport time (OR = 0.97, 95% CI = 0.95–0.99). The per-milliliter administration of IV fluids, while statistically significant, was not clinically relevant (OR = 1.001, 95% CI = 1.00–1.01). The AUCROC was 75.1% predictive. Conclusions: These results suggest that older patients with worsening hemodynamic status are more likely to receive TXA, while those with longer transport times are less likely to receive TXA. More research is needed on the appropriate use of TXA with PPH patients.
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