Language-Based Inequities in Transfusion Practices with Obstetric Hemorrhage.

IF 1.7 4区医学 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Maternal and Child Health Journal Pub Date : 2025-07-01 Epub Date: 2025-07-08 DOI:10.1007/s10995-025-04118-2

Alexa Cohen, Samantha Goulding, Carly Pickett, Beatrice Lynch, Osaro Obanor, Melissa Peskin-Stolze, Pe'er Dar, Georgios Doulaveris

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引用次数: 0

Abstract

Objectives: Inequities in race, ethnicity and socioeconomic status have been well documented in postpartum hemorrhage (PPH) and hemorrhage-associated morbidity. However, little is known about the impact of language barriers on maternal outcomes in PPH. Our study aim was to investigate language-based inequities in maternal outcomes among gravidas with PPH.

Methods: This is a retrospective cohort of patients with PPH who delivered at an urban academic institution between January 2020 and December 2022. Maternal language is categorized as English primary language (EPL) or non-English primary language (NEPL). PPH is defined as a quantitative blood loss (QBL) greater than 1000 mL within 24 h of delivery. QBL is a calculated measurement of peripartum and postpartum blood loss. Primary outcome is transfusion of packed red blood cells (pRBC). Secondary outcomes include transfusion of 4 + units of pRBC, disseminated intravascular coagulation (DIC) and admission to intensive care unit (ICU). Multivariable logistic regression was used to estimate the association of primary language with maternal outcomes.

Results: 1723 patients with PPH were included: 1314 (76.3%) with EPL and 409 (23.7%) with NEPL. English-speaking and non-English speaking patients had similar QBL rates (1530.2 ± 634.2 vs 1496.0 ± 668.1, p = 0.3). However, transfusion rates were lower in those with NEPL, when compared to EPL (28.2% vs 22.9%, p = 0.039). After adjusting for age, race/ethnicity, nulliparity, body mass index, pre-eclampsia and pre-delivery anemia, gravidas with NEPL were less likely to be transfused compared with EPL (aOR 0.7, 95% CI 1.012-1.806, p = 0.04). Rates of DIC, ICU admission and transfusion of 4 + units of pRBC were similar between groups. CONCLUSIONS FOR PRACTICE: Despite a similar postpartum blood loss, patients with NEPL had lower rates of blood transfusion in PPH compared to patients with EPL. Further research is needed in health literacy and language proficiency that may impede access to transfusion in patients with PPH.

查看原文本刊更多论文

产科出血输血实践中基于语言的不平等。

目的：种族、民族和社会经济地位的不平等在产后出血（PPH）和出血相关发病率中有很好的记录。然而，人们对语言障碍对PPH产妇结局的影响知之甚少。我们的研究目的是调查PPH孕妇中基于语言的产妇结局不平等。方法：这是一项对2020年1月至2022年12月在城市学术机构分娩的PPH患者的回顾性队列研究。母语分为英语母语（EPL）和非英语母语（NEPL）。PPH被定义为分娩24小时内定量失血量（QBL）大于1000 mL。QBL是围生期和产后出血量的计算测量。主要结局是输血填充红细胞（pRBC）。次要结局包括输注4个以上单位的pRBC、弥散性血管内凝血（DIC）和入住重症监护病房（ICU）。使用多变量逻辑回归来估计母语与产妇结局的关系。结果：共纳入PPH患者1723例：EPL 1314例（76.3%），NEPL 409例（23.7%）。英语和非英语患者QBL发生率相似（1530.2±634.2 vs 1496.0±668.1,p = 0.3）。然而，与EPL患者相比，NEPL患者的输血率较低（28.2% vs 22.9%, p = 0.039）。在调整了年龄、种族/民族、无产、体重指数、先兆子痫和产前贫血等因素后，与EPL孕妇相比，NEPL孕妇输血的可能性更低（aOR为0.7,95% CI为1.012-1.806,p = 0.04）。两组间DIC、ICU入院率和4 +单位pRBC输注率相似。实践结论：尽管产后失血相似，与EPL患者相比，NEPL患者在PPH中的输血率较低。需要对可能妨碍PPH患者获得输血的卫生知识和语言熟练程度进行进一步研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Maternal and Child Health Journal PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-

CiteScore

3.20

自引率

4.30%

发文量

271

期刊介绍： Maternal and Child Health Journal is the first exclusive forum to advance the scientific and professional knowledge base of the maternal and child health (MCH) field. This bimonthly provides peer-reviewed papers addressing the following areas of MCH practice, policy, and research: MCH epidemiology, demography, and health status assessment Innovative MCH service initiatives Implementation of MCH programs MCH policy analysis and advocacy MCH professional development. Exploring the full spectrum of the MCH field, Maternal and Child Health Journal is an important tool for practitioners as well as academics in public health, obstetrics, gynecology, prenatal medicine, pediatrics, and neonatology. Sponsors include the Association of Maternal and Child Health Programs (AMCHP), the Association of Teachers of Maternal and Child Health (ATMCH), and CityMatCH.