Up to 5% of patients in the United States have a postpartum hemorrhage. "Postpartum hemorrhage" means excessive bleeding after delivery. The majority of these bleeds occur immediately with delivery. The current study focuses on hemorrhages that occur in the "medium-term" (1.5-24 hours after delivery). Investigators are examining whether ultrasound exams performed at the beginning of this period 1.5 to 2 hours after birth can identify markers that predict a medium-term bleed. Data collected for this study will include medical and obstetrical history, details about the course and outcomes of patients' labor and delivery, and particulars about postpartum bleeding. This information will be collected through the end of the patients' delivery admission and will allow correlation with the results of the ultrasound exam. If patients are re-admitted to the hospital after the delivery discharge, investigators may also collect relevant information about those admissions up to 6 weeks postpartum. All patients after term delivery (≥ 37 weeks' gestation) will be eligible to participate. Patients will be approached to provide consent for participation as early as feasible during a prenatal visit (≥ 36 weeks' gestation) or during the delivery admission. No subjects will be consented while in significant pain, \>6cm dilated without an epidural, or \>8cm dilatated with an epidural.
Study Type
OBSERVATIONAL
Enrollment
1,725
Postpartum ultrasound exam
Endeavor Health
Evanston, Illinois, United States
RECRUITINGUltrasound exam: uterine measurements
* Uterine length (cm) * Uterine width (cm) * Uterine height (cm) These will be correlated with subsequent clinical outcomes, including bleeding events.
Time frame: From enrollment to 1.5-2 hours post partum
Ultrasound exam: endometrial stripe
Width (cm) of the endometrial stripe (measuring displacement of the uterine walls by intrauterine contents (blood, clots, retained placental fragments or other) to include Doppler study) at 3 levels: * Fundal * Lower uterine segment * Cervix These will be correlated with subsequent clinical outcomes, including bleeding events.
Time frame: From enrollment to 1.5-2 hours post partum
Ultrasound exam:fibroids
Presence of uterine fibroids (number and size in cm of each) These will be correlated with subsequent clinical outcomes, including bleeding events.
Time frame: From enrollment to 1.5-2 hours post partum
Ultrasound exam: Vagina
Caliber of the vagina (cm) (to assess distension by clot) These will be correlated with subsequent clinical outcomes, including bleeding events.
Time frame: From enrollment to 1.5-2 hours post partum
Ultrasound exam: Bladder
* Bladder length (cm) * Bladder height (cm) * Bladder width (cm) All other aspects of clinical management will be left to the discretion of the clinical team. These will be correlated with subsequent clinical outcomes, including bleeding events.
Time frame: From enrollment to 1.5-2 hours post partum
Chart review
Outcome measures for this study will include details about the postpartum course up to 6 weeks postpartum. This will allow correlation with the results of the ultrasound exam. If patients are re-admitted to the hospital after the delivery discharge, investigators will also collect relevant information about those admissions.
Time frame: From enrollment to 6 weeks post partum
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