Gyamfi-Bannerman C, et al. - Researchers sought to assess the association of race with adverse maternal outcomes in the setting of postpartum hemorrhage. They identified black women to be at higher risk for severe morbidity and mortality associated with postpartum hemorrhage.

Methods

• Researchers undertook this retrospective cohort study utilizing the National (Nationwide) Inpatient Sample (NIS) from the Agency for Healthcare Research and Quality for the years 2012 to 2014.
• Included were the women aged 15 to 54 with a diagnosis of postpartum hemorrhage.
• Categorization of race and ethnicity was performed as follows: non-Hispanic white, non-Hispanic black, Hispanic, Asian or Pacific Islander, Native American, other, and unknown.
• They analyzed an overall risk for severe morbidity based on Centers for Disease Control and Prevention criteria along with risk for specific outcomes such as disseminated intravascular coagulation, hysterectomy, transfusion, and maternal death.
• They stratified risk for severe morbidity by comorbid risk and compared it by race.
• They applied weights to create population estimates.
• They created log-linear regression models to determine risk for severe morbidity with risk ratios and associated 95% confidence intervals as measures of effect.

Results

• This analysis included a total of 360,370 women with postpartum hemorrhage from 2012 to 2014.
• Significantly higher risk for severe morbidity was noted 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<0.01).
• Non-Hispanic black women, compared to non-Hispanic white, Hispanic, and Asian or Pacific Islander women, demonstrated higher risk for disseminated intravascular coagulation (8.4% vs 7.1%, 6.8%, and 6.8% respectively, p<0.01) and transfusion (19.4% vs 13.9%, 16.1%, and 15.8% respectively, p<0.01).
• Furthermore, black women more frequently underwent hysterectomy compared to non-Hispanic white women (2.4% vs 1.9%, p<0.01), although Asian or Pacific Islander women were at highest risk (2.9%).
• Adjusting for comorbidity, higher risk for severe morbidity was continually observed among black women (p<0.01).
• Non-Hispanic black women demonstrated significantly higher risk for death than for non-black women (121.8 per 100,000 deliveries, 95% CI 94.7-156.8 vs 24.1 per 100,000 deliveries, 95% CI 19.2-30.2, respectively, p<0.01).