Language-Based Inequities in Transfusion Practices with Obstetric Hemorrhage

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.

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.

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.