Maternal and clinical characteristics associated with sulprostone failure in postpartum haemorrhage after vaginal delivery: A retrospective cohort study

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OBJECTIVE: To identify maternal and clinical characteristics associated with sulprostone failure in the management of postpartum haemorrhage (PPH) following vaginal delivery. DESIGN: Retrospective cohort study using Bayesian multivariable logistic regression. SETTING: Two French university hospitals. PARTICIPANTS: Women aged ≥ 18 years, with a gestational age of 26-42 weeks, who experienced PPH after vaginal delivery and received sulprostone between January 2019 and December 2020. MAIN OUTCOME MEASURES: Failure of sulprostone, defined as the need for one or more invasive procedures (intrauterine balloon tamponade, arterial embolisation, conservative surgery, or hysterectomy). RESULTS: Among 217 women treated with sulprostone, the failure rate was 25.8 % (56/217). Sulprostone failure was independently associated with previous caesarean section (ORa = 2.31, 95 % CrI: 1.17-4.53; Pr(OR > 1) = 0.99), episiotomy (ORa = 1.93, 95 % CrI: 1.00-3.68; Pr(OR > 1) = 0.98), and history of PPH (ORa = 1.83, 95 % CrI: 1.02-3.27; Pr(OR > 1) = 0.98). A higher shock index at sulprostone administration was also associated with failure (ORa = 2.29, 95 % CrI: 1.31-4.07; Pr(OR > 1) = 0.99). CONCLUSIONS: Sulprostone failure was associated with specific maternal and haemodynamic factors. Improved identification of high-risk cases may help optimise treatment pathways and reduce the need for invasive procedures. Further studies are warranted to assess the role of uterotonic choice and previous uterine surgery. CLINICAL TRIALS IDENTIFIER: NCT06164236.

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