Does Hemorrhage Risk Stratification Correlate With Need for Intervention and Subsequent Maternal Morbidity? [13M

Abstract

INTRODUCTION: Postpartum hemorrhage (PPH) is a leading cause of preventable maternal morbidity and mortality. In order to identify women prior to delivery at higher risk for hemorrhage, a trinary risk assessment tool has been developed. However, its utility has only been correlated to transfusion need. We sought to compare hemorrhage risk stratification with need for intervention and subsequent maternal morbidity. METHODS: We analyzed antepartum and intrapartum hemorrhage risk factors using the California Maternal Quality Care Collaborative’s risk score in all deliveries at our institution between January 1, 2018 and December 31, 2018. Relevant factors were used to stratify women as low, medium, or high risk which was then correlated to uterotonic administration beyond oxytocin and other hemorrhage-related morbidity. PPH was defined as blood loss exceeding 1,000 mL. Data was analyzed using standard methods of rates and proportions with P<.05 considered significant. IRB approval was obtained from the UT Southwestern Medical Center. RESULTS: Of 1,868 deliveries, 508 women (27.2%) experienced a PPH. Overall, 178 (9.5%) required uterotonics, 38 (2.0%) required transfusion, 7 (0.4%) needed intensive care unit (ICU) admission, and 12 (0.6%) underwent hysterectomy. Relative to low and medium risk stratifications, high risk women were 2.3 times more likely to require uterotonics. Low risk women were 83% less likely to require transfusion, ICU, or hysterectomy compared to medium and high risk groups. Conversely, high risk women had a 4.1 fold increase in these morbidities. CONCLUSION: Women classified as high risk for hemorrhage are indeed more likely to require uterotonics and suffer disproportionately higher maternal morbidity.