Gutierrez-Disla Rubinnis, Gheewala Rachana, Fogel Joshua, Jacobs Allan J
Department of Obstetrics and Gynecology, NYC/H+H - South Brooklyn Health, Brooklyn, New York, USA.
Department of Management, Marketing, and Entrepreneurship, Brooklyn College, Brooklyn, New York, USA.
Proc (Bayl Univ Med Cent). 2024 Nov 5;38(1):7-14. doi: 10.1080/08998280.2024.2419193. eCollection 2025.
Risk assessment tools are used by clinicians to predict which patients might have excessive bleeding. We studied the association between a peripartum hemorrhage risk assessment score using peripartum quantified blood loss (QBL) among those with vaginal deliveries who are often at lower risk for peripartum hemorrhage.
In this retrospective analysis of 1221 patients with term vaginal deliveries at a public New York City hospital, the Association of Women's Health, Obstetric and Neonatal Nurses (AWOHNN) risk assessment tool was used to categorize patients as low risk, medium risk, or high risk for postpartum hemorrhage.
Low-risk scores were present in 925 (75.8%) patients, medium-risk scores in 268 (21.9%) patients, and high-risk scores in 28 (2.3%) patients. Outcome variables consisted of QBL (M = 213.8, SD = 215.00 mL), QBL ≥ 500 mL (n = 89, 7.3%), and ratio of postdelivery hematocrit to predelivery hematocrit (M = 0.9, SD = 0.08). High-risk score (B = 0.14, SE = 0.07, = 0.04) but not medium-risk score was significantly associated with increased QBL as compared to low-risk score. Body mass index (BMI) measured as a continuous variable was significantly associated with increased QBL (B = 0.004, SE = 0.002, = 0.049). However, BMI measured as a categorical variable using the AWOHNN cutoff score of >35 was not significantly associated with QBL. AWOHNN score was not significantly associated with QBL ≥ 500 mL or with the ratio of postdelivery hematocrit with predelivery hematocrit.
We recommend revising the AWOHNN measure to better reflect medium risk and to consider a different approach for BMI use as part of the AWOHNN risk score.
临床医生使用风险评估工具来预测哪些患者可能会出现过度出血。我们研究了在通常围产期出血风险较低的阴道分娩患者中，使用围产期定量失血量（QBL）的围产期出血风险评估评分之间的关联。
在对纽约市一家公立医院1221例足月阴道分娩患者的回顾性分析中，使用女性健康、产科和新生儿护士协会（AWOHNN）风险评估工具将患者分类为产后出血低风险、中风险或高风险。
925例（75.8%）患者为低风险评分，268例（21.9%）患者为中风险评分，28例（2.3%）患者为高风险评分。结局变量包括QBL（M = 213.8，SD = 215.00 mL）、QBL≥500 mL（n = 89，7.3%）以及产后血细胞比容与产前血细胞比容之比（M = 0.9，SD = 0.08）。与低风险评分相比，高风险评分（B = 0.14，SE = 0.07，P = 0.04）而非中风险评分与QBL增加显著相关。作为连续变量测量的体重指数（BMI）与QBL增加显著相关（B = 0.004，SE = 0.002，P = 0.049）。然而，使用AWOHNN >35的临界值作为分类变量测量的BMI与QBL无显著关联。AWOHNN评分与QBL≥500 mL或产后血细胞比容与产前血细胞比容之比无显著关联。
我们建议修订AWOHNN测量方法，以更好地反映中风险，并考虑将BMI的不同使用方法作为AWOHNN风险评分的一部分。
