Research Article

Racial Differences in Postpartum Bleeding: A Retrospective Study at a Large Southeastern U.S. Medical Center

Authors: Callista Osley MS, Todd Anderson, Emily Carletto MS, David Schutzer.

DOI: 10.33425/2639-9342.1285

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Abstract

Background: Postpartum hemorrhage (PPH) is a major contributor to maternal morbidity and mortality, with significant racial disparities in obstetric outcomes. This study investigates racial and ethnic differences in postpartum blood loss at a large Southeastern medical center.

Methods: This retrospective cohort study analyzed 23,047 singleton births at Cape Fear Valley Health from January 1, 2020, to December 31, 2024, using SlicerDicer on EPIC. Delivery methods included 13,375 spontaneous vaginal deliveries and 8,388 cesarean sections. Postpartum blood loss recorded within 24 hours post-delivery was compared across racial groups using chi-square tests and standardized residuals to assess significant differences.

Results: Blood loss distribution following vaginal delivery varied significantly among racial groups (χ² = 39.00, p < 0.00001). Hispanic patients had a disproportionately higher rate of blood loss in the 500–1000 mL range (standardized residual = 4.06), while African American/Black patients exhibited a greater incidence of severe hemorrhage (>1500 mL). Native American patients had lower-than-expected rates of blood loss <500 mL. White patients experienced PPH at rates closest to expected distributions, with 7% of vaginal deliveries resulting in PPH (>500 mL) and 6.7% of cesarean deliveries resulting in PPH (>1000 mL). Among African American/Black patients, the corresponding rates were 7.2% for vaginal and 8.7% for cesarean deliveries. Hispanic patients had the highest rate of vaginal delivery-related PPH at 10.5%, while their cesarean-related PPH rate was 8.2%. Native American patients had the lowest blood loss, with 7.9% of vaginal deliveries and 6.5% of cesarean deliveries resulting in PPH. Disparities in blood loss following cesarean section were not statistically significant (χ² = 13.22, p = 0.353).

Conclusions: Significant racial disparities in PPH risk were observed, particularly among African American/ Black and Hispanic patients. Further research into clinical and sociodemographic contributors is necessary to address these disparities and improve maternal outcomes.

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