OBJECTIVES: We describe resource use and costs among hospital births involving abnormal postpartum uterine bleeding or postpartum hemorrhage (PPH).

METHODS: This was a retrospective, observational study of all births associated with abnormal postpartum uterine bleeding or PPH in the US Premier Healthcare Database (Jan 2016-March 2022). PPH was defined by ≥1 ICD-10 code. Second-line uterotonic (UT) use beyond oxytocin, or tranexamic acid use, was a proxy for abnormal postpartum uterine bleeding. Costs were from the hospital’s perspective (Oct 2022 $USD).

RESULTS: Among 5,345,753 births, 14.7% (n=787,964) had a PPH diagnosis or received second-line UTs. Mean age was 29.0 years, 50.7% were non-Hispanic white, and 34.1% were cesarean births. Methylergonovine (51.9%), misoprostol ≥800 mcg (47.0%), and carboprost (15.4%) were the most frequently used UTs. Tranexamic acid use was 11.1%. Only 1 UT was administered in 70.3% and 11.7% received 3+ UTs. Balloon tamponade was used in 2.7%, 7.2% received a blood transfusion, 1.6% had an ICU admission, and 0.5% had a hysterectomy. Mean ± SD total hospital costs were $7,939 ± 6,631 ($9,380 ± 7,551 for 3+ UTs) for vaginal births and $13,072 ± 12,674 ($15,917 ± 16,466 for 3+ UTs) for cesarean births. Mean ± SD length of stay was 2.4 ± 1.8 (vaginal) and 3.8 ± 3.7 days (cesarean). The major cost drivers were non-ICU room and board (vaginal: $3,160 ± 3,155; cesarean: $4,843 ± 5,995), surgery (vaginal: $2,049 ± 2,501; cesarean: $3,608 ± 3,657), and pharmacy (vaginal: $451 ± 1,126; cesarean: $826 ± 2,007).

CONCLUSIONS: The observed rate of abnormal postpartum uterine bleeding or PPH was relatively high, and these cases were associated with substantial clinical and economic burden. Costs tended to increase with increasing number of UTs administered. Earlier intervention may help to improve outcomes and reduce overall healthcare resource use.