Fonge, Yaneve
(2024)
Understanding the Role of the Focused Assessment with Sonography for Trauma in Preventing Maternal Morbidity and Mortality due to Postpartum Hemorrhage.
Master Essay, University of Pittsburgh.
Abstract
Objective: Decreased time to intervention in postpartum hemorrhage (PPH) improves maternal outcomes. Strategies to achieve timely intervention is of great public health importance as maternal mortality rates from PPH in the United States are rising. We sought to identify if using Focused Assessment with Sonography for Trauma (FAST) exams during evaluation of PPH following cesarean delivery affects time to interventions.
Study Design: This is a retrospective cohort study of women who underwent a cesarean delivery that was complicated by PPH. Demographic and outcome data were compared between those who received a FAST exam after delivery and those who did not receive a FAST exam as part of their evaluation. The primary outcome was the time to a composite of interventions (admission to the intensive care unit, reoperation, or interventional radiology procedure within 48 hours of delivery) analyzed using Survival Models adjusted for propensity score weights. Secondary outcomes included hysterectomy, length of hospital stay (LOS) and transfusion morbidity.
Results: A total of 1,128 women with PPH following cesarean delivery were included in this analysis. 113 (10.0%) women had a FAST exam as part of their evaluation. Demographic variables were balanced between groups; with the exception of estimated blood loss (p <.0001) and etiology for PPH (p <.0001). Mean time to intervention was 8 hours shorter in the FAST exam group compared to usual care (39.2 hours after delivery versus 47.2 hours after delivery, respectively, p < 0.0001)). After propensity score weighting, the FAST exam group still received interventions 3.8 hours faster than the usual care group (FAST exam: 43.4 hours, versus Usual care: 47.2 hours, p = .026). There was no difference in rate of hysterectomy (FAST 2% vs. usual care 1%, p=1.0). LOS was 1.4 days longer in the FAST group (p < .0001). While transfusion rates were also higher in the FAST exam group (FAST exam: 73% vs. usual care 23%, p <.0001), patients in the FAST group received fewer units of packed red blood cells (p <.0001).
Conclusion: FAST exams may lead to more timely interventions in PPH. Prospective studies are warranted to validate these findings.
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Details
| Item Type: |
Other Thesis, Dissertation, or Long Paper
(Master Essay)
|
| Status: |
Unpublished |
| Creators/Authors: |
|
| Contributors: |
| Contribution | Contributors Name | Email | Pitt Username | ORCID  |
|---|
| Committee Member | Hershey, Tina | tbh16@pitt.edu | tbh16 | UNSPECIFIED | | Committee Member | Himes, Katherine | katherine.p.himes@hitchcock.org | UNSPECIFIED | UNSPECIFIED | | Committee Chair | Feghali, Maisa | feghalim@mwri.magee.edu | UNSPECIFIED | UNSPECIFIED |
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| Date: |
21 May 2024 |
| Date Type: |
Completion |
| Submission Date: |
21 April 2024 |
| Access Restriction: |
2 year -- Restrict access to University of Pittsburgh for a period of 2 years. |
| Number of Pages: |
23 |
| Institution: |
University of Pittsburgh |
| Schools and Programs: |
School of Public Health > Multidisciplinary MPH |
| Degree: |
MPH - Master of Public Health |
| Thesis Type: |
Master Essay |
| Refereed: |
Yes |
| Uncontrolled Keywords: |
Focused Assessment with Sonography for Trauma , FAST exam, postpartum hemorrhage |
| Date Deposited: |
21 May 2024 13:30 |
| Last Modified: |
21 May 2024 13:30 |
| URI: |
http://d-scholarship.pitt.edu/id/eprint/46226 |
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