Cynthia Gyamfi-Bannerman1, Sindhu K Srinivas2, Jason D Wright1, Dena Goffman1, Zainab Siddiq1, Mary E D'Alton1, Alexander M Friedman3. 1. Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY. 2. Department of Obstetrics and Gynecology, Perelman School of Medicine, the University of Pennsylvania, Philadelphia, PA. 3. Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY. Electronic address: amf2104@cumc.columbia.edu.
Abstract
BACKGROUND: How race is associated with adverse outcomes in the setting of postpartum hemorrhage is not well characterized. OBJECTIVE: The objective of this study was to assess how race is associated with adverse maternal outcomes in the setting of postpartum hemorrhage. STUDY DESIGN: This retrospective cohort study utilized the National (Nationwide) Inpatient Sample (NIS) from the Agency for Healthcare Research and Quality for the years 2012-2014. Women aged 15-54 years with a diagnosis of postpartum hemorrhage were included. Race and ethnicity were categorized as non-Hispanic white, non-Hispanic black, Hispanic, Asian or Pacific Islander, Native American, other, and unknown. Overall risk for severe morbidity based on Centers for Disease Control and Prevention criteria was analyzed along with risk for specific outcomes such as disseminated intravascular coagulation, hysterectomy, transfusion, and maternal death. Risk for severe morbidity was stratified by comorbid risk and compared by race. Weights were applied to create population estimates. Log-linear regression models were created to assess risk for severe morbidity with risk ratios and associated 95% confidence intervals as measures of effect. RESULTS: A total of 360,370 women with postpartum hemorrhage from 2012 to 2014 were included in this analysis. Risk for severe morbidity was significantly higher among non-Hispanic black women (26.6%) than non-Hispanic white, Hispanic, or Asian or Pacific Islander women (20.7%, 22.5%, and 21.4%, respectively, P < .01). For non-Hispanic black compared with non-Hispanic white, Hispanic, and Asian or Pacific Islander women risk was higher for disseminated intravascular coagulation (8.4% vs 7.1%, 6.8%, and 6.8%, respectively, P < .01) and transfusion (19.4% vs 13.9%, 16.1%, and 15.8%, respectively, P < .01). Black women were also more likely than non-Hispanic white women to undergo hysterectomy (2.4% vs 1.9%, P < .01), although Asian or Pacific Islander women were at highest risk (2.9%). Adjusting for comorbidity, black women remained at higher risk for severe morbidity (P < .01). Risk for death for non-Hispanic black women was significantly higher than for nonblack women (121.8 per 100,000 deliveries, 95% confidence interval, 94.7-156.8 vs 24.1 per 100,000 deliveries, 95% confidence interval, 19.2-30.2, respectively, P < .01). CONCLUSION: Black women were at higher risk for severe morbidity and mortality associated with postpartum hemorrhage.
BACKGROUND: How race is associated with adverse outcomes in the setting of postpartum hemorrhage is not well characterized. OBJECTIVE: The objective of this study was to assess how race is associated with adverse maternal outcomes in the setting of postpartum hemorrhage. STUDY DESIGN: This retrospective cohort study utilized the National (Nationwide) Inpatient Sample (NIS) from the Agency for Healthcare Research and Quality for the years 2012-2014. Women aged 15-54 years with a diagnosis of postpartum hemorrhage were included. Race and ethnicity were categorized as non-Hispanic white, non-Hispanic black, Hispanic, Asian or Pacific Islander, Native American, other, and unknown. Overall risk for severe morbidity based on Centers for Disease Control and Prevention criteria was analyzed along with risk for specific outcomes such as disseminated intravascular coagulation, hysterectomy, transfusion, and maternal death. Risk for severe morbidity was stratified by comorbid risk and compared by race. Weights were applied to create population estimates. Log-linear regression models were created to assess risk for severe morbidity with risk ratios and associated 95% confidence intervals as measures of effect. RESULTS: A total of 360,370 women with postpartum hemorrhage from 2012 to 2014 were included in this analysis. Risk for severe morbidity was significantly higher among non-Hispanic black women (26.6%) than non-Hispanic white, Hispanic, or Asian or Pacific Islander women (20.7%, 22.5%, and 21.4%, respectively, P < .01). For non-Hispanic black compared with non-Hispanic white, Hispanic, and Asian or Pacific Islander women risk was higher for disseminated intravascular coagulation (8.4% vs 7.1%, 6.8%, and 6.8%, respectively, P < .01) and transfusion (19.4% vs 13.9%, 16.1%, and 15.8%, respectively, P < .01). Black women were also more likely than non-Hispanic white women to undergo hysterectomy (2.4% vs 1.9%, P < .01), although Asian or Pacific Islander women were at highest risk (2.9%). Adjusting for comorbidity, black women remained at higher risk for severe morbidity (P < .01). Risk for death for non-Hispanic black women was significantly higher than for nonblack women (121.8 per 100,000 deliveries, 95% confidence interval, 94.7-156.8 vs 24.1 per 100,000 deliveries, 95% confidence interval, 19.2-30.2, respectively, P < .01). CONCLUSION: Black women were at higher risk for severe morbidity and mortality associated with postpartum hemorrhage.
Authors: Jonathan M Snowden; Sarah S Osmundson; Menolly Kaufman; Cori Blauer Peterson; Katy Backes Kozhimannil Journal: Health Serv Res Date: 2020-07-16 Impact factor: 3.402
Authors: Mary E D'Alton; Alexander M Friedman; Peter S Bernstein; Haywood L Brown; William M Callaghan; Steven L Clark; William A Grobman; Sarah J Kilpatrick; Daniel F O'Keeffe; Douglas M Montgomery; Sindhu K Srinivas; George D Wendel; Katharine D Wenstrom; Michael R Foley Journal: Am J Obstet Gynecol Date: 2019-03-05 Impact factor: 8.661
Authors: Cynthia Gyamfi-Bannerman; Ambika Pandita; Eliza C Miller; Amelia K Boehme; Jason D Wright; Zainab Siddiq; Mary E D'Alton; Alexander M Friedman Journal: J Matern Fetal Neonatal Med Date: 2019-02-20
Authors: Karen A Scott; Brittany D Chambers; Rebecca J Baer; Kelli K Ryckman; Monica R McLemore; Laura L Jelliffe-Pawlowski Journal: BMC Pregnancy Childbirth Date: 2020-10-06 Impact factor: 3.007