[F31] Improving Postpartum Hemorrhage Care in Resource-Constrained Settings: Risk Factors and Optimized Care
Ente: National Heart Lung and Blood Institute
Scadenza: 2028-12-31
Importo max: 49.282 EUR
Paese: US
Descrizione
Postpartum hemorrhage (PPH) is one of the leading causes of maternal death worldwide and remains a major
cause of preventable maternal morbidity and mortality in the United States. The proposed study will
characterize PPH including population characteristics, treatment outcomes, and management practices with
the primary purpose of generating actionable insights into PPH management that directly inform clinical care
and quality improvement in both low-resource and U.S. settings. The study is set in N’Djamena, Chad, a
country with one of the highest maternal mortality ratios globally. Conducting this research in a high-burden
setting enables efficient identification of high-risk populations, evaluation of significant predictors, and detection
of gaps in care delivery that are more difficult to observe in lower-incidence settings such as the United States.
Findings will be used to inform evidence-based strategies for improving risk stratification, optimizing treatment
processes, and strengthening adherence to obstetric safety protocols, priorities directly relevant to U.S.
maternal health systems. Aim 1 will characterize postpartum hemorrhage. We will use descriptive analyses of
causes, characteristics, and treatments among women experiencing PPH. We will apply traditional statistical
and machine learning approaches to identify predictive risk factors for hemorrhage, generating models that can
inform risk assessment strategies applicable to U.S. clinical care. Aim 2 will assess treatment outcomes and
risk factors for PPH. Using hierarchical clustering, nested logistic regression, and latent class analysis (LCA),
we will classify treatment pathways and model treatment effectiveness. These analyses will identify distinct
patient subgroups and inform stratified management approaches relevant to improving outcomes in
heterogeneous U.S. obstetric populations. Aim 3 will describe PPH management processes and decisionmaking. Through in-depth interviews with care providers, we will characterize barriers and facilitators to
adherence to obstetric safety bundles using the COM-B framework. Findings will inform implementation
strategies to improve adherence to evidence-based practices, an ongoing challenge in U.S. hospital systems.
While focused on pregnancy in Chad, with one of the highest maternal and infant mortality rates in the world,
the lessons learned will be applicable directly to the United States, given the vastness of our rural regions (the
American south, west, and Alaska, most notably). As the F31 trainee, I will apply lessons learned to our nation.
Istituzione: GEORGE WASHINGTON UNIVERSITY
PI: Margaret Louise Anderson
Progetto: 1F31HL184922-01
Settori: National Heart Lung and Blood Institute
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