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INTRODUCTION

Obstetric hemorrhage is one of the leading causes of preventable maternal morbidity and mortality worldwide.1 Numerous hemorrhage risk evaluation tools are available; however, there remains a gap in resources and implementation. In a retrospective cohort analysis of multicenter databases including 56,903 women, composite maternal morbidity occurred at a rate of 2.2%, 8%, and 11.9% within low-risk, medium-risk, and high-risk groups, respectively.2 The goal of establishing an evaluation tool for obstetric hemorrhage is to identify patient populations who could benefit from risk-reducing interventions.

Three published risk-assessment tools include:

  • The Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) hemorrhage risk-prediction tool3

  • The American College of Obstetricians and Gynecologists (ACOG) Safe Motherhood Initiative4

  • California Maternal Quality Care Collaborative (CMQCC) obstetric hemorrhage risk factor assessment screen1

Evaluation of obstetric hemorrhage risk is an ongoing process. In our medical center, risk evaluation occurs at admission, during labor, postpartum; current risk (H-score) is presented at “Team Meetings” (Chapter 29, “Whiteboard and Team Meeting”). Understanding that the risk factors can escalate during labor is critical for clinical preparation and management.

The unique advantage of risk-assessment tool at Beth Israel Deaconess Medical Center (BIDMC) is linked to actions and preparation (Table 34-1).5

TABLE 34-1Beth Israel Deaconess Medical Center Obstetric Hemorrhage Risk Evaluation Tool5

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