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Clinical Obstetrics

Poster Session 4

(940) Predictors of Maternal Morbidity Among Individuals at Low-Risk of Postpartum Hemorrhage

Wednesday, February 14, 2024
1:00 PM – 2:30 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective:

To identify risk factors for maternal morbidity among individuals categorized as low-risk for postpartum hemorrhage (PPH) according to ACOG Practice Bulletin (#183), a modification of the California Maternal Quality Care Collaborative (CMQCC) version 2 schema.

Study Design: A case-control study of all singleton births between March 2020 and February 2022 at a single Level IV center. Individuals deemed at moderate or high risk for PPH according to the ACOG risk stratification and those with missing body-mass index (BMI) data were excluded. Cases were individuals who experienced maternal hemorrhagic morbidity, defined as a composite maternal hemorrhagic outcome (CMHO). Controls were individuals without the composite morbidity. Variables previously associated with maternal morbidity, not included in the ACOG stratification, were analyzed. Multivariable logistic regression was applied to identify factors independently associated with the outcome. The predictive values of the possible risk factors were assessed using a receiver operating characteristic (ROC) curve.

Results:

Of the 8,623 consecutive deliveries in the study period 3,465 (40%) met inclusion criteria, and among them 173 (5%) had a CHMO. Individuals with CHMO were older, had a higher BMI, and were more likely to be of Hispanic race/ethnicity, have diabetes mellitus, post-term pregnancy, and a large for gestational age newborn. In the multivariable analysis, all factors but diabetes remained significantly associated with the CHMO. The combined presence of any of these 3 risk factors was associated with a CHMO rate of 28% (13/46) and yielded a positive likelihood ratio of 7.50 (95% confidence interval [CI] 4.02-13.98; Table 1). The ROC curve generated an area under the curve of 0.63 (95% CI 0.62-0.65). Subgroup analyses of individuals that underwent either labor (3,022; 87%) or planned cesarean delivery (443; 13%) yielded similar results.

Conclusion:

Among individuals identified with low-risk for PPH according to the ACOG risk stratification, several risk factors of maternal morbidity were identified, albeit of low predictive value.