Prophylactic Uterotonic Use in Grandmultiparas Reduces Recurrent Postpartum Bleeding
ACOG ePoster. Misal M. Apr 27, 2018; 212046; 32O
Meenal Misal
Meenal Misal
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Introduction: Grand multiparity is a risk factor for postpartum hemorrhage (PPH). We evaluated whether prophylactic uterotonics in grandmultiparas reduced the incidence of recurrent postpartum bleeding. 

Methods: This retrospective cohort study of grandmultiparas who underwent vaginal delivery between January 2011 and December 2015 compared women who received postpartum prophylactic uterotonics (other than routinely given oxytocin) to women who did not. A uterotonic was deemed prophylactic if so recorded by the delivering physician or if given within 1 hour of delivery with no other indication documented. Physician re-evaluation of vaginal bleeding was chosen as the primary outcome as a proxy for clinically significant recurrent bleeding. A multivariable logistic model was used to compare rates of physician re-evaluation between groups receiving prophylactic uterotonics versus none.

Results: Of the 356 grandmultiparas, 53 (15%) received a prophylactic uterotonic. Women with 7-11 deliveries were more likely to receive prophylactic uterotonics than those with 4-6. Hispanic women were also more likely to receive prophylactic uterotonics. There were no other significant differences in demographic or obstetric factors.

PPH rate was similar for both groups (6% vs. 6%, P=.79). However, the adjusted rate of physician re-evaluation was six-fold higher for women who did not receive prophylactic uterotonics (OR: 6.08 [95% CI 1.2 - 29.7] P=0.03). Of those who did not receive prophylactic uterotonics and required physician re-evaluation, 46% subsequently received an additional uterotonic.

Conclusion/Implications: The rate of physician re-evaluation for recurrent postpartum bleeding was six-fold higher for grandmultiparas who did not receive prophylactic uterotonics post-delivery. Administration of prophylactic uterotonics may benefit this high-risk population.
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