(P-TS-75) Likelihood of Transfusion Following Postpartum Hemorrhage Differs Based on Maternal Race and Educational Attainment

Background/Case Studies: Postpartum hemorrhage (PPH) is a common and significant delivery complication. A mainstay of management includes transfusion of red blood cells (RBCs). Although common, RBC transfusion is not without its risks, including transfusion reactions and the risk of RBC

alloimmunization complicating future pregnancies. This study investigates whether transfusion rates among individuals diagnosed with

postpartum hemorrhage differ across different socioeconomic groups.

Study

Design/Methods:
This study is a retrospective cohort study of all patients at a single hospital labor and delivery unit identified as having PPH, as defined by quantitative or estimated blood loss greater than or equal to 1000 mL. The cohort was divided by receipt of a postpartum blood transfusion versus no transfusion. These groups were then reviewed for differences in receipt of transfusion based on characteristics such as race, primary language, and insurance status. Additionally, possible confounders were analyzed, including parity, diagnosis of pre-eclampsia, and usage of oxytocin and/or magnesium during the intrapartum period.

Results/Findings: From January 1, 2013, to December 31, 2024, 4,578 people were identified as having PPH. Of those, 1,117 people were transfused (24%). Compared to people who self-identified as White; Asian, Hispanic (non-US born), and Hispanic (US born) individuals had a higher likelihood of transfusion with adjusted odds ratios of 1.70 (95% CI 1.44, 2.01; p< 0.001), 1.61 (95% CI 1.13, 2.28;  p=0.007), and 1.44 (95% CI 1.09, 1.88; p=0.010), respectively. Additionally, although not statistically significant, educational attainment also trends towards a higher likelihood of transfusion with less education, such that individuals with less than a high school diploma are 1.55 (95% CI 0.95, 2.45; p=0.069) times more likely to be transfused compared to those with some college/college graduate.

Conclusions:
This study used a single-site cohort of individuals with PPH to identify socioeconomic factors that could predispose individuals to receiving a transfusion. Maternal race was identified as a key risk factor, with Asian or Hispanic self-identifying individuals being most likely to receive a transfusion. Given the risks of transfusion and previous work identifying those of Hispanic descent as overrepresented in an in utero transfusion cohort, this data supports a need to implement standardization of PPH management criteria.