Childbirth is the most common reason for hospital admission in the United States (US). Not only has overall maternal morbidity and mortality been increasing, but significant and continuing racial and ethnic disparities have been demonstrated for both. Postpartum hemorrhage (PPH), one of the leading causes of maternal morbidity and mortality in the US, is more common among minority women, who also experience worse PPH- related outcomes than non-minority white women. 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. Understanding which factors are contributing to the disparity has significant implications with regard to developing effective and sustainable solutions. Previous studies that have explored racial/ethnic disparities in PPH outcomes have used state or national datasets, which lack granular, patient-level factors, as well as, information on provider management of PPH. 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, thus providing detailed patient-level information. The form also includes critical provider- and system-level information allowing for a highly-detailed investigation of the sources of racial/ethnic disparities. We propose to use these data from 2007-2017 to achieve the following aims: (1) Evaluate whether risk factors for PPH differ by race/ethnicity; (2) 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) 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. Such findings are fundamental to the development of effective and sustainable solutions to reduce the observed disparities in PPH 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.
Postpartum hemorrhage (PPH) is a significant contributor to maternal morbidity and mortality in the United States. Racial/ethnic disparities in the frequency and severity of PPH exist, yet the etiology of these disparities, and actions that can be employed to reduce them, are not well understood. This study will identify contributing factors for racial/ethnic disparities in the frequency and severity of PPH, which can then be used to develop interventions targeted at reducing these disparities.
