医学
产科
回顾性队列研究
接收机工作特性
妇产科学
风险评估
怀孕
输血
妇科
急诊医学
外科
内科学
计算机安全
生物
计算机科学
遗传学
作者
Vani C. Movva,Jay Bringman,Amanda Young,Celia Gray,A. Dhanya Mackeen,Michael J. Paglia
出处
期刊:Transfusion
[Wiley]
日期:2023-03-29
卷期号:63 (5): 1005-1010
摘要
Abstract Background To adequately predict significant postpartum hemorrhage (PPH) at hospital admission, we evaluated and compared the accuracy of three risk assessment tools: 1. California Maternal Quality Care Collaborative (CMQCC), 2. American College of Obstetrics and Gynecology Safe Motherhood Initiative (ACOG SMI) and 3. Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN). Study Design and Methods This is a retrospective cohort study of people who delivered liveborn infants from January 2018 to June 2021 at our center. Patients with comorbidities necessitating higher hemoglobin values, those who refused blood transfusions, and missing pertinent data were excluded. Significant PPH was defined as a blood transfusion within 48 hours following delivery. Diagnostic statistics were calculated for each tool. Results Of the 11,679 included pregnancies, 232 (1.9%) people had significant PPH. Amongst those diagnosed as high‐risk by the CMQCC tool, 67/1485 (4.5%) had significant PPH; 62/1672 (3.7%) by the ACOG SMI tool, and 85/1864 (4.6%) by the AWHONN tool had significant PPH. All tools have low sensitivity and high negative predictive values. The area under the receiver operating characteristics curve of the three tools is moderately poor (CMQCC: 0.58, ACOG SMI: 0.55, AWHONN:0.61). Discussion Upon admission to labor and delivery, all three studied tools are poor predictors of significant PPH. The development and validation of better PPH risk stratification tools are required with the inclusion of additional important variables.
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