LAUSR

661 Obstetric hemorrhage management among obese women Aleksandra Polic, Stephanie Ros, Judette Louis University of South Florida Morsani College of Medicine, Tampa, FL OBJECTIVE: We sought to evaluate the impact of obesity on the management and outcomes of postpartum hemorrhage. STUDY DESIGN: We conducted a retrospective cohort study including all women who delivered at a tertiary center during 2/1/2013-12/31/ 2014. Medical charts were reviewed for clinical and sociodemographic data. Hemorrhage related severe morbidity indicators included blood transfusion, shock, acute renal failure, transfusion related lung injury, cardiac arrest and use of interventional radiology procedures. Obese (BMI 30kg/m) and nonobese women were compared. The data was analyzed using chi-square, student t-test, Mann Whitney U test, and logistic regression where appropriate. P < 0.05 was significant. RESULTS: There were 9,890 deliveries and 2.9% (n1⁄4287) were complicated by obstetric hemorrhage. The sample population of obese and non-obese women did not differ in race, ethnicity or insurance status. The obese women with hemorrhage were more likely to have a macrosomic infant (18.6 vs. 8.9%, p1⁄40.03), have delivered by cesarean section, (71% vs 29%, p1⁄40.008), undergo a cesarean section after labor (30.4% vs 11.9%, p1⁄40.001), and have a higher quantitative blood loss (1281 vs 1042 ml, p1⁄4.01). Both groups were equally likely to receive carboprost, methylergonovine and misoprostol but obese women were more likely to need >2 doses of uterotonic agents (66% vs. 34%, p1⁄40.04). There was no difference in the decision to proceed to the operating room (11.8 % vs 20.5%, p1⁄40.39), Bakri balloon (11.8% and 7.7%, p1⁄40.72), use of interventional radiology (5.8% vs 6.5%, p1⁄40.99), or the decision to proceed with hysterectomy (8% vs 5.2%, p1⁄40.57). The two groups were similar in the time to first treatment and time to stabilization, and there was no difference in the need for blood transfusion (29.2 vs 24.7, p1⁄4.47) or number of units of blood transfused (2.2 vs. 2.1 units, p1⁄4.25). Obese women were equally likely to experience a severe morbidity (50.5% vs 41%, p1⁄40.34), but more likely to experience more than one severe morbidity (28.4% vs 10.3%, p1⁄40.03). After controlling for confounding variables, time to stabilization (hr.) [or 1.06 (95%CI 1.006-1.13)], and admission hemoglobin [aOR 0.63 (95%CI 0.49-0.84] neither obesity nor management were predictive of severe morbidity. CONCLUSION: Compared to normal weight women, obese women with postpartum hemorrhage required more doses of uterotonic agents and had more severe morbidity despite similar management.