174: How well does assessing hemorrhage risk on admission correspond with peripartum morbidity?

Abstract

To evaluate the extent to which a novel assessment of hemorrhage risk on admission corresponds with morbidity in the peripartum period. This retrospective cohort analysis of a multicenter database included women admitted to labor and delivery from June 2016 to June 2018. A novel nursing assessment developed by Association of Women's Health, Obstetric and Neonatal Nurses was used to categorize patients as low, medium or high risk for hemorrhage. Outcomes related to blood transfusion, estimated blood loss (EBL) ≥ 1000cc, ICU admission, general anesthesia and oxytocin use were evaluated based on hemorrhage risk score. Data were available for 56,671 births. There were 14,861 low risk (26%), 26,080 (46%) moderate risk, and 15,730 (28%) high risk. There were a total of 275 women (0.5%) who had blood transfusion and 3,717 women (6.6%) with EBL ≥ 1000cc. Tracking shell level (low/medium/high) designation is significantly associated with all the outcomes examined (Table). For women with high risk scores, the relative risk ratio compared with low risk women was 4.9 (95% CI 3.2-7.4) for blood transfusion and 5.2 (4.6-5.9) for EBL ≥ 1000cc. Only 9.5% of women (26/275) who were categorized as low risk for hemorrhage required a blood transfusion. For high versus low risk and the outcome of EBL ≥ 1000cc, the sensitivity was 85%, specificity was 51%, positive predictive value 10%, negative predictive value 98%. Women who scored high risk for hemorrhage on admission had five times higher risk for blood transfusion and EBL ≥ 1000cc compared to low risk women. Given the low incidence of the outcomes explored, the hemorrhage risk assessment on admission works moderately well to identify peripartum morbidity.