Black women less likely to receive higher level antihemorrhagic interventions
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Black women experiencing postpartum hemorrhage requiring blood transfusion were less likely to receive higher levels of antihemorrhagic intervention compared with their white counterparts.
The findings were presented at the Society for Reproductive Investigation Annual Meeting.
“Research nationwide has repeatedly shown that Black women experience greater maternal morbidity and mortality,” Carolyn S. Guan, an MD candidate at the Johns Hopkins School of Medicine, and Arthur (Jason) Vaught, MD, director of labor and delivery and assistant professor of gynecology and obstetrics at Johns Hopkins, told Healio.
“This disparity has been hypothesized to arise from multiple sources, one of which is the quality of care received in the health care system,” they said. “We sought to take a deeper dive into one of the leading causes of maternal morbidity and mortality — postpartum hemorrhage (PPH) — and characterize the kinds of interventions women receive to manage their condition.”
Guan, Vaught and colleagues retrospectively reviewed electronic health records for 368 patients with PPH and blood product transfusion and ranked the antihemorrhagic interventions that were used. They defined level one intervention as uterotonics use only, level two as procedures such as embolization and B-Lynch suture and level three as hysterectomy.
Level one intervention was used in 217 women (59%), level two was used in 117 women (31.8%) and level three was used in 34 women (9.2%). Higher levels of intervention were significantly associated with greater estimated blood loss, more transfusions and older maternal age, according to the study.
Black and Latino women were significantly less likely to receive higher levels of intervention compared with white women (P = .029), the researchers said.
When adjusting for maternal age and placenta accreta spectrum, Black women remained significantly less likely to receive a higher level of intervention (adjusted OR = 0.59; 95% CI, 0.36-0.99). The odds did not reach significance for Latino women (aOR = 0.61; 95% CI, 0.32-1.16) in the adjusted analysis, according to the researchers.
“We expected that, with more blood loss, management would become more consistent and the disparity would disappear,” Guan and Vaught said. “However, instead we found that even at three or more liters of blood loss the disparity persisted and even increased in significance, with Black women remaining less likely to receive more intensive care (OR = 0.25, 95% CI, 0.08-0.79).”
They suggested that future studies expand upon their findings with larger patient populations; examine provider biases and patient advocacy; and investigate ways to reduce disparities, such as implicit bias training or standardizing interventions.