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Am J Perinatol 2021; 38(11): 1192-1200
DOI: 10.1055/s-0040-1712166
Original Article

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

Halley Ruppel
1   Division of Research, Kaiser Permanente Northern California, Oakland, California
,
Vincent X. Liu
1   Division of Research, Kaiser Permanente Northern California, Oakland, California
,
Neeru R. Gupta
2   Department of Obstetrics and Gynecology, Kaiser Permanente Medical Center, San Francisco, California
,
Lauren Soltesz
1   Division of Research, Kaiser Permanente Northern California, Oakland, California
,
Gabriel J. Escobar
1   Division of Research, Kaiser Permanente Northern California, Oakland, California
› Author Affiliations Funding This work was supported by The Permanente Medical Group, Inc., and Kaiser Foundation Hospitals, Inc.
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Abstract

Objective This study aimed 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.

Study Design 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 ≥1,000 mL) 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.

Results Using the standard definition, postpartum hemorrhage occurred in approximately 5% of hospitalizations (n = 13,479), with a rate of 3.2, 10.5, and 10.2% in the low-, medium-, and high-risk groups. Severe postpartum hemorrhage occurred in 824 hospitalizations (0.3%), with a rate of 0.2, 0.5, and 1.3% in the low-, medium-, and high-risk groups. For either definition, the odds of postpartum hemorrhage were significantly higher in medium- and high-risk groups compared with 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.

Conclusion 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 nonobstetrical factors.

Keywords

obstetrics - postpartum hemorrhage - risk assessment - risk stratification

Note

Some results of this work were presented at a poster session at the Academy Health Annual Research Meeting, June 2 to 4, 2019 in Washington, DC.


Supplementary Material



Publication History

Received: 18 October 2019

Accepted: 13 April 2020

Article published online:
26 May 2020

© 2020. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
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