Implementation of a standardized protocol for postpartum anemia: a prospective cohort study.

Abstract

Objective Implementation of standardized protocols for antepartum anemia increases intravenous iron (IVFe) use and improves pre-delivery 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 December 2021, recommends (1) IVFe for postpartum Hb 7.0-8.9 g/dL and (2) oral iron for postpartum Hb 9.0-9.9 g/dL. We compared all postpartum inpatients at a single site in April 2021 (PRE) to April 2022 (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 805 patients were included (PRE=401; POST=404). Patients in the PRE and POST group differed in ethnicity (PRE: 8.2% Hispanic vs. POST: 14.9% Hispanic, p=0.003). IVFe use significantly increased from PRE to POST-implementation (PRE: 6.0% vs. POST: 11.1%, p=0.009) even when controlling for differences between groups (aOR 2.48, 95% CI [1.08-5.67]). Patients receiving IVFe in the POST group were more likely to receive the recommended three doses of IVFe compared to 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.