BACKGROUND
Obstetrical hemorrhage is a leading cause of severe maternal morbidity, a key indicator
of a nation's healthcare delivery system and often associated with a high rate of
preventability. Limited data suggest that a patient's hemorrhage risk score may be
associated with risk for maternal morbidity such as severe hemorrhage, intensive care
unit admission, or transfusion. Little is known regarding the relationship between
hemorrhage risk score and nontransfusion-related morbidity.
OBJECTIVE
We sought to evaluate the association between a patient's California Maternal Quality
Care Collaborative admission hemorrhage risk score and severe maternal morbidity.
STUDY DESIGN
This was a retrospective cohort of delivery admissions from 2018 to 2019 in a single
healthcare network. Admission risk scores were assigned to each patient using the
California Maternal Quality Care Collaborative criteria. Rates of transfusion- and
nontransfusion-associated severe maternal morbidity were compared across low-, medium-,
and high-risk strata. We defined severe maternal morbidity as the presence of any
International Classification of Diseases diagnosis or procedure codes outlined by
the Centers for Disease Control and Prevention, need for intensive care unit admission,
or prolonged postpartum hospital length of stay. A multivariable logistic regression
was used to assess the association between hemorrhage risk score and severe maternal
morbidity.
RESULTS
In the overall cohort, severe maternal morbidity occurred in 2.4% (n=517) of all deliveries.
Excluding cases requiring transfusion, 0.6% (n=131) of cases still had a severe maternal
morbidity event. The incidence of severe maternal morbidity was 1.6% (n=264) in patients
categorized as low risk for hemorrhage compared with 2.5% (n=118) and 13.6% (n=135)
in patients who were categorized as medium or high risk for hemorrhage, respectively
(P<.001). Patients classified as high risk had a significant association with both severe
maternal morbidity (adjusted odds ratio, 8.8; 95% confidence interval, 7.0–11) and
nontransfusion-associated severe maternal morbidity (adjusted odds ratio, 3.6; 95%
confidence interval, 2.2–5.9).
CONCLUSION
In addition to predicting the risk for obstetrical hemorrhage and transfusion, our
findings indicate that the California Maternal Quality Care Collaborative admission
hemorrhage risk tool predicts risk for transfusion- and nontransfusion-associated
severe maternal morbidity. Our findings imply that despite awareness and the identification
of patients at high risk for obstetrical hemorrhage on admission, significant hemorrhage-associated
morbidity persisted. Our data indicate that the identification of risk alone may be
insufficient to reduce morbidity and imply that further work is needed to investigate
and implement new practices in response to a patient's score stratum.
Key words
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Article info
Publication history
Published online: May 31, 2021
Accepted:
May 26,
2021
Received in revised form:
May 20,
2021
Received:
March 15,
2021
Footnotes
The authors report no conflict of interest.
This study received no financial support.
Cite this article as: Phillips JM, Hacker F, Lemon L, et al. Correlation between hemorrhage risk prediction score and severe maternal morbidity. Am J Obstet Gynecol MFM 2021;XX:x.ex–x.ex.
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