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Q&A

Clinical Obstetrics

Poster Session 2

(590) Does Documentation of Postpartum Hemorrhage Risk Stratification Affect Maternal Outcomes?

Tuesday, February 13, 2024
3:30 PM – 5:00 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective:

Postpartum hemorrhage risk stratification (RS) at admission to labor and delivery is increasingly used as a quality metric. However, a reduction in adverse outcomes with risk stratification has not yet been established. We hypothesized that documented RS by RN or MD as compared to no RS is associated with a significant reduction in composite adverse maternal hemorrhagic outcomes (CAMHO).

Study Design:

This was a retrospective cohort study of all singleton gestations who delivered at a single-level IV center within a year. Cases were categorized into one of 3 groups: i) no RS (control); ii) RS by RN only, or; iii) RS by MD / RN. The CAMHO included the following: blood loss ≥ 1,000 mL, use of uterotonics, mechanical tamponade, surgical management of atony, blood transfusion, hysterectomy, thromboembolism, admission to intensive care unit, and maternal death. Multivariable Poisson regression models were used to calculate relative risks (aRR) adjusted for possible confounders along with 95% confidence intervals (CI).

Results:

Of the 4,544 total deliveries, 4,404 (96.9%) were included and among them 783 (18%) had no RS documented, 2,141 (49%) had RS by RN only, and 1,480 (33%) had RS by MD/RN. Overall, 941 (21.5%) of participants had CAMHO with the rate being similar among the groups: 21.5% in no RS group, 20.7% in RN only group, and 22.4% in MD/RN group. Compared to controls, the aRR for CAMHO was 1.01 (95% CI 0.84-1.12 when RS was done by RN and 1.06 (95% CI 0.97-1.18), when RS was done by MD/RN). None of the components of CAMHO, including the administration of uterotonics, differed between the 3 groups.

Conclusion:

Compared to those who did not have risk stratification prior to delivery, patients who had RS performed in labor by RN alone or by MD/RN had no reduction in adverse maternal hemorrhagic outcomes. Further trials are needed to determine if risk stratification affects behavior and outcomes in labor and delivery.