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Category: Clinical Obstetrics
Poster Session II
ACOG promulgates classification of individuals admitted for delivery into three-tiers for postpartum hemorrhage (PPH): Low-, Medium-, or High-Risk. We sought to report the frequency of each tier and the clinical outcomes linked to each one.
Study Design: Over 12 consecutive months, charts of all singletons who delivered at a Level IV maternal center were reviewed. Multiple gestations and those transferred after delivery were excluded. Using pre-defined criteria, chart abstraction was done by qualified medical personnel, and data quality was audited on 10% of the charts by staff not involved in data abstraction. Using the California Maternal Quality Care Collaborative (CMQCC) schema, with the known risk factors until delivery, all singletons were categorized into three tiers. PPH was defined as estimated or quantitative blood loss ³1,000 mL. We contrasted risks of composite maternal morbidity (CMM) among all classification groups, with a relative risk (RR) with a 95% confidence interval (CI) as the effect measure calculated using Poisson regression adjusted for potential confounders.
Results:
Of the 4,516 singletons, 1,854 (41%) were categorized as being low-risk, 1,239 (27%) were medium-, and 1423 (32%) as high-risk. The risk factors for the 3 groups are in Table 1. The risk of CMM was 19% higher in the medium versus low-risk groups (RR 1.19, 95% CI 1.03-1.36) and 16% higher comparing high versus low-risk groups (RR 1.16, 95% CI 1.02-1.32), but not amongst the medium vs. high-risk groups (aRR 0.98, 95% CI 0.85-1.12). Blood loss of at least 1,000 mL and transfusion followed a similar pattern to the CMM (Table 2). The three maternal deaths were not directly related to PPH.
Conclusion:
At our Level IV maternal center, the three-tiered postpartum hemorrhage classification performed poorly since over 1 out 5 “low-risk” had hemorrhagic sequelae and no difference in outcomes was noted between medium versus high-risk groups. A better predictive model is needed for PPH and associated morbidity.
Ipsita Ghose, DO
Department of Obstetrics, Gynecology, and Reproductive Services McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth)
Houston, Texas, United States
Rachel L. Wiley, MD, MPH
Resident
Department of Obstetrics, Gynecology and Reproductive Sciences McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth)
Houston, Texas, United States
Hailie Ciomperlik, BA
Univ. of Texas Medical School at Houston
Houston, Texas, United States
John Biebighauser, BS
University of Texas-Houston Medical School
Houston, Texas, United States
Kathy Mostajeran, DO, MPH
Resident physician
HCA Gulf Coast Education Consortium
Houston, Texas, United States
Rylee Trotter, BS
University of Texas-Houston Medical School
Houston, Texas, United States
Rachel T. Nguyen, BS
Student
University of Texas Health Science Center at Houston
Houston, Texas, United States
Marissa Mosher, PA-C
University of Texas-Houston Medical School
Houston, Texas, United States
Jeanne C. Cardenas, BS
McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth)
Houston, Texas, United States
Chloe Denham, BS
University of Texas-Houston Medical School
Houston, Texas, United States
Candice Schwartzenburg, MD
University of Texas-Houston Medical School
Houston, Texas, United States
Baha M. Sibai, MD
Professor
Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth)
Houston, Texas, United States
Sean C. Blackwell, MD
Professor
Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth)
Houston, Texas, United States
Suneet P. Chauhan, MD
Professor
Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth)
Houston, Texas, United States
Hector Mendez Figueroa, MD
Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth)
Houston, Texas, United States