(1077) Does ultrasound contribute to clinical management of women with subclinical post partum hemorrhage–prospective cohort study

Postpartum Hemorrhage (PPH) is the third leading cause for maternal death in the USA. It was demonstrated that hemoglobin (Hb) drop≥2g/dL was associated with PPH. Yet, many cases are subclinical, since overt hemorrhage did not precede the drop in Hb. The utility of ultrasound (US) in the management of the subclinical cases is not clear.

We aimed to elucidate whether US may contribute to the management of women with subclinical PPH, i.e. at least 2g Hb drop from baseline without reporting on overt bleeding.

Study Design:

Prospective cohort trial. In our department all women perform Hb test before and several hours after delivery. Women after vaginal delivery (normal or with vacuum) without documentation of abnormal bleeding were divided, according to their postpartum Hb drop from baseline, to subclinical PPH group (Hb drop≥2 g/dL) and to a control group (Hb drop< 2 g/dL) in a ratio of 1:2. Women who performed US right after delivery were excluded. The primary outcome was the rate of women with a pathological finding on US examination (abdominal or vaginal). Assuming that the rate of pathological findings in the US examination will be 30% of the women in the subclinical PPH group compared to 10% of the women in the control group, the required sample size was 44 and 88 women in the subclinical PPH and control group, respectively (5% 2-sided alpha, 80% power).

Results:

Characteristics and outcomes are presented in tables 1 and 2. The rate of pathological findings on US was 1 (2%) and 3 (3%) of women in the subclinical PPH and control groups, respectively (P=1). US led to intervention (misoprostol and later on hysteroscopy for placental tissue removal) only in one (1%) woman in the control group (table).  The rest of the women reported on normal US examination in the 6-weeks post-partum visit.

Conclusion:

In subclinical PPH, US did not contribute to the clinical management of those women.