Validation of Postpartum Hemorrhage Admission Risk Factor Stratification in a Large Obstetrics Population.

Validation of Postpartum Hemorrhage Admission Risk Factor Stratification in a Large Obstetrics Population.

To evaluate the performance of the California Maternal Quality Care Collaborative (CMQCC) admission risk criteria for stratifying postpartum hemorrhage risk in a large obstetrics population. Using detailed electronic health record data, we classified 261,964 delivery hospitalizations from Kaiser Permanente Northern California hospitals between 2010 and 2017 into high, medium and low-risk groups based on CMQCC criteria. We used logistic regression to assess associations between CMQCC risk groups and postpartum hemorrhage using two different postpartum hemorrhage definitions, standard postpartum hemorrhage (blood loss ≥ 1,000mL) and severe postpartum hemorrhage (based on transfusion, laboratory and blood loss data). Among the low risk group, we also evaluated associations between additional present-on-admission factors and severe postpartum hemorrhage. Using the standard definition, postpartum hemorrhage occurred in about 5% of hospitalizations (n=13,479), with a rate of 3.2% in the low risk, 10.5% in the medium risk and 10.2% in the high risk group. Severe postpartum hemorrhage occurred in 824 hospitalizations (0.3%), with a rate of 0.2% in the low risk, 0.5% in the medium risk and 1.3% the high risk group. For either definition, the odds of postpartum hemorrhage were significantly higher in medium and high risk groups compared to the low risk group. Over 40% of postpartum hemorrhages occurred in hospitalizations that were classified as low risk. Among the low risk group, risk factors including hypertension and diabetes were associated with higher odds of severe postpartum hemorrhage. We found that the CMQCC admission risk assessment criteria stratified women by increasing rates of severe postpartum hemorrhage in our sample, which enables early preparation for many postpartum hemorrhages. However, the CMQCC risk factors missed a substantial proportion of postpartum hemorrhages. Efforts to improve postpartum hemorrhage risk assessment using present-on-admission risk factors should consider inclusion of other non-obstetrical factors.

评估加利福尼亚孕产妇优质护理协作组织（CMQCC）的入院风险标准在大量产科人群中对产后出血风险进行分层的效果。 利用详细的电子健康记录数据，我们根据CMQCC标准，将2010年至2017年间北加州凯撒医疗集团医院的261,964例分娩住院病例分为高、中、低风险组。我们使用逻辑回归，采用两种不同的产后出血定义，即标准产后出血（失血量≥1000毫升）和严重产后出血（基于输血、实验室检查和失血量数据），来评估CMQCC风险组与产后出血之间的关联。在低风险组中，我们还评估了其他入院时存在的因素与严重产后出血之间的关联。 按照标准定义，约5%的住院病例发生了产后出血（n = 13,479），低风险组发生率为3.2%，中风险组为10.5%，高风险组为10.2%。824例住院病例发生了严重产后出血（0.3%），低风险组发生率为0.2%，中风险组为0.5%，高风险组为1.3%。对于任何一种定义，中风险组和高风险组产后出血的几率均显著高于低风险组。超过40%的产后出血发生在被归类为低风险的住院病例中。在低风险组中，包括高血压和糖尿病在内的风险因素与严重产后出血的较高几率相关。 我们发现，CMQCC入院风险评估标准在我们的样本中通过严重产后出血发生率的增加对女性进行了分层，这使得能够对许多产后出血情况进行早期准备。然而，CMQCC风险因素遗漏了相当大比例的产后出血情况。利用入院时存在的风险因素改进产后出血风险评估的工作应考虑纳入其他非产科因素。