IMPROVING POSTPARTUM HEMORRHAGE CARE IN RESOURCE-CONSTRAINED SETTINGS: RISK FACTORS AND OPTIMIZED CARE - 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.