OBJECTIVE: Assess whether inclusion of intrapartum risk factors improves our obstetric hemorrhage risk stratification tool in predicting obstetric hemorrhage, transfusion, and related severe morbidity. STUDY DESIGN: This is a retrospective cohort study using all live deliveries at a single institution over a two-year period (n = 5,332). Obstetric hemorrhage risk factors, hemorrhage burden, and severe maternal morbidity index outcomes were assessed through chart abstraction. Hemorrhage risk was assessed at: 1. “Time of Admission” through chart abstraction and 2. “Pre-delivery” by calculation after inclusion of all abstracted intrapartum risk factors. Admission high-risk was compared to pre-delivery high-risk for sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio in predicting obstetric hemorrhage, obstetric hemorrhage requiring transfusion, and obstetric hemorrhage related severe morbidity. Significance levels were calculated using descriptive statistical methods including chi-squared tests and McNemar tests. RESULTS: The sensitivities of the risk assessment tool using admission risk classification for high-risk patients is: 25% for obstetric hemorrhage, 37% for obstetric hemorrhage requiring transfusion, and 22% for obstetric hemorrhage related severe morbidity. After intrapartum factor inclusion, the sensitivities increase to: 55% for obstetric hemorrhage, 59% for obstetric hemorrhage requiring transfusion, and 47% for obstetric hemorrhage related severe morbidity. This “pre-delivery” risk assessment is significantly more sensitive across all three end points (p < 0.001 for all three outcomes). While the positive likelihood ratios for obstetric hemorrhage are equal on admission and pre-delivery (2.10 on admission and pre-delivery), they increase after intrapartum factor inclusion for obstetric hemorrhage requiring transfusion and obstetric hemorrhage related severe morbidity (on admission, 2.74 and 1.6, respectively, and pre-delivery: 4.57 and 3.58, respectively). CONCLUSION: Inclusion of intrapartum risk factors increases the accuracy of this obstetric hemorrhage risk stratification tool in predicting patients requiring hemorrhage management with transfusion and obstetric hemorrhage related severe morbidity.

Purpose: Prolonged duration of intrapartum oxytocin exposure is included as a risk factor within widely adopted obstetric hemorrhage risk strati cation tools. However, the duration of exposure that confers increased risk is poorly understood. This study aimed to assess the association between duration of intrapartum oxytocin exposure and obstetric blood loss, as measured by quantitative blood loss, and hemorrhage-related maternal morbidity.Methods: This was a retrospective cohort study of all deliveries from 2018 to 2019 at a single medical center. We included patients who had received any intrapartum oxytocin, and we categorized them into 1 of 5 groups: >0-2, ≥2-4, ≥4-6, ≥6-12, and ≥12 hours of intrapartum oxytocin exposure. The primary outcomes were mean quantitative blood loss, proportion with obstetric hemorrhage (de ned as quantitative blood loss ≥ 1000 mL), and proportion with obstetric hemorrhage-related morbidity, a composite of hemorrhage-related morbidity outcomes. Secondary outcomes were hemorrhage-related pharmacologic and procedural interventions. A strati ed analysis was also conducted to examine primary and secondary outcomes by delivery mode.

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Purpose: Prolonged duration of intrapartum oxytocin exposure is included as a risk factor within widely adopted obstetric hemorrhage risk stratification tools. However, the duration of exposure that confers increased risk is poorly understood. This study aimed to assess the association between duration of intrapartum oxytocin exposure and obstetric blood loss, as measured by quantitative blood loss, and hemorrhage-related maternal morbidity. Methods: This was a retrospective cohort study of all deliveries from 2018 to 2019 at a single medical center. We included patients who had received any intrapartum oxytocin, and we categorized them into 1 of 5 groups: >0-2, ≥2-4, ≥4-6, ≥6-12, and ≥12 hours of intrapartum oxytocin exposure. The primary outcomes were mean quantitative blood loss, proportion with obstetric hemorrhage (defined as quantitative blood loss ≥ 1000 mL), and proportion with obstetric hemorrhage-related morbidity, a composite of hemorrhage-related morbidity outcomes. Secondary outcomes were hemorrhage-related pharmacologic and procedural interventions. A stratified analysis was also conducted to examine primary and secondary outcomes by delivery mode. Results: Of 5,332 deliveries between January 1, 2018 to December 31, 2019 at our institution, 2232 (41.9%) utilized oxytocin for induction or augmentation. 326 (14.6%) had exposure of >0-2hr, 295 (13.2%) ≥2-4hr, 298 (13.4%) ≥4-6hr, 562 (25.2%) ≥6-12hr, and 751 (33.6%) ≥12hr. Across all deliveries, there was higher mean quantitative blood loss (p<0.01) as well as increased odds of obstetric hemorrhage (adjusted odds ratio [aOR] 1.52, 95% confidence interval [CI]: 1.21-1.91) for those with ≥12hr of oxytocin compared to all groups between >0-12hr of exposure. In our stratified analysis, ≥12hr of oxytocin exposure was associated with higher mean quantitative blood loss (p=0.04) and odds of obstetric hemorrhage in vaginal deliveries (aOR 1.47, 95% CI: 1.03-2.11), though not in cesarean deliveries (aOR 1.16, 95% CI: 0.82-1.62). There were no differences in proportion with obstetric hemorrhage-related morbidity across all deliveries (p=0.40) or in the stratified analysis. Conclusion: Intrapartum oxytocin exposure of ≥12 hours was associated with increased quantitative blood loss and odds of obstetric hemorrhage in vaginal, but not cesarean, deliveries.

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