Clinical Obstetrics
Poster Session 2
Rachel L. Wiley, MD,MPH (she/her/hers)
Assistant Professor
McGovern Medical School at UTHealth Houston
Houston, TX, United States
Ipsita Ghose, BS,DO
University of Texas Medical School at Houston
Houston, TX, United States
Hector Mendez Figueroa, MD
University of Texas Health Science Center at Houston
Houston, TX, United States
Suneet P. Chauhan, MD
Professor
University of Texas-Houston Medical School
Houston, TX, United States
In 2022, the California Maternal Quality Care Collaborative published Version 3 of the Hemorrhage Toolkit (CMQCC V3). We compared the likelihood of postpartum hemorrhagic morbidity (PPH-M) with CMQCC V3 risk assessment screen compared to the classification schema promulgated by ACOG’s Practice Bulletin (#183; published in 2017).
Study Design:
This was a retrospective cohort of all singletons delivered at > 14 weeks at a Level IV center during 24 months. Chart abstraction was done by qualified medical staff, and the risk stratification was calculated at delivery. A composite PPH-M was defined as in Figure 1, and we assessed the predictive accuracies of the models by calculating AUC (area under the curve) for receiver-operating curves (ROC). A secondary analysis to examine risk of PPH-M with stratification by CMQCC V3 was compared, and adjusted risk ratios calculated using multivariable Poisson regression models.
Results:
Of 8,623 consecutive deliveries in the study period, 8,357 (97%) were singletons. For the CMQCC V3, 2,562 (31%) were low-, 3,084 (37%) were medium- and 2,711 (32%) were classified as high-risk. ACOG classified 3,475 (42%) as low-, 2,430 (29%) as medium- and 2,452 (29%) as high-risk. The models agreed approximately 55% of the time (kappa 0.33, “fair” agreement). Figure 1 shows the ROC curves in predicting PPH-M, with an AUC of 0.61 (95% CI 0.60 – 0.63) for CMQCC V3 and 0.57 (95% CI 0.56-0.59) for ACOG, which is significantly in favor of CMQCC (p< 0.001). The sensitivity of CMQCC was increased compared to ACOG (58% to 50%), but the specificity decreased (46% to 61%). A secondary analysis examined risk of PPH-M in CMQCC V3, and found that PPH-M was increased for high risk group when compared to low (aRR 1.88, 95% CI 1.65-2.14) or medium (aRR 1.78, 95% CI 1.59-1.99), but medium was not increased compared to low.
Conclusion:
In our population, the CMQCC V3 is more likely to label patients at jeopardy for PPH-M as high-risk as compared to current ACOG risk stratification, however its utilization in clinical practice to improve outcomes remains uncertain.