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DOI: 10.1055/a-2414-1262
Implementation of a Standardized Protocol for Postpartum Anemia: A Prospective Cohort Study
Funding This work was funded by the Thomas B. McCabe and Jeannette E. Laws McCabe Fund and the Eunice Kennedy Shriver National Institute for Child Health and Development (grant number: K23 HD102523; principal investigator R.F.H.). U.S. Department of Health and Human Services, National Institutes of Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development.
Abstract
Objective
Implementation of standardized protocols for antepartum anemia increases intravenous iron (IVFe) use and improves predelivery hemoglobin (Hb). However, this condition is often overlooked and inadequately treated in postpartum care settings. We aimed to determine if implementation of a standardized protocol for postpartum anemia increases postpartum IVFe use and affects clinical outcomes.
Study Design
We performed a prospective cohort study evaluating implementation of a standardized inpatient protocol for postpartum anemia. This protocol, implemented in December 2021, recommends (1) IVFe for postpartum Hb 7.0 to 8.9 g/dL and (2) oral iron for postpartum Hb 9.0 to 9.9 g/dL. We compared all postpartum inpatients at a single site from April 2021 (preimplementation period [PRE]) to April 2022 (postimplementation period [POST]). The primary outcome was any IVFe use. Secondary outcomes included number of IVFe doses, oral iron supplementation at discharge, postpartum complications, and length of stay.
Results
A total of 805 patients were included (PRE = 401; POST = 404). Patients in the PRE and POST groups differed in ethnicity (PRE: 8.2% Hispanic vs. POST: 14.9% Hispanic, p = 0.003). IVFe use significantly increased from PRE to POST (PRE: 6.0% vs. POST: 11.1%, p = 0.009) even when controlling for differences between groups (adjusted odds ratio: 2.48, 95% confidence interval: [1.08–5.67]). Patients receiving IVFe in the POST group were more likely to receive the recommended three doses of IVFe compared with patients receiving IVFe in the PRE group (POST: 29% vs. PRE: 4%, p = 0.04). Patients in the POST group had shorter lengths of stay than in the PRE group (POST: 1.69 days vs. PRE: 1.81 days, p < 0.001). There were no significant differences in blood transfusion, oral iron supplementation, or postpartum complications.
Conclusion
Implementation of a standardized protocol for postpartum anemia increased IVFe use without increasing length of stay.
Key Points
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Postpartum anemia is associated with postpartum depression, fatigue, impaired cognition, and altered maternal–infant bonding.
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IVFe is more effective and better tolerated than oral iron.
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Implementation of standardized protocols for antepartum anemia has been shown to increase IVFe use.
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Implementation of a standardized protocol for postpartum anemia increased IVFe use without increasing length of stay.
Note
Data from these manuscript were presented as a poster presentation at the 43rd annual pregnancy meeting of the Society for Maternal-Fetal Medicine, San Francisco, CA, February 6–11, 2023.
Publication History
Received: 03 April 2024
Accepted: 11 September 2024
Accepted Manuscript online:
19 September 2024
Article published online:
08 October 2024
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