title: Implementation of an obstetric hemorrhage risk assessment: validation and evaluation of its impact on pretransfusion testing and hemorrhage outcomes.
abstract: OBJECTIVE
  To evaluate the impact of an obstetric hemorrhage risk assessment on pretransfusion testing and hemorrhage outcomes at a tertiary care, academic medical center.
  
  
  METHODS
  A retrospective cohort study was performed among women delivering neonates≥24 weeks from 2009 to 2011. Demographics, pretransfusion testing rates and hemorrhage outcomes were compared between those delivering before and after implementation of the risk assessment. Multivariable analyses were used to determine predictors of postpartum hemorrhage and transfusion.
  
  
  RESULTS
  There were 1388 women delivering before and 2121 women delivering after implementation of the risk assessment. More pretransfusion testing occurred after the assessment was initiated (22.8% versus 15.0%). Those who were considered high-risk were more likely to experience hemorrhage outcomes. In multivariable analyses, physician ordering practice in the pre-risk assessment period was a better prognosticator of both postpartum hemorrhage (aOR 9.98, 95% CI 5.02-19.82) and transfusion (aOR 31.14, 95% CI 14.97-64.82) than completion of a cross-match after implementation of the risk assessment (postpartum hemorrhage: aOR 2.10, 95% CI 1.20-3.66, transfusion: aOR 6.31, 95% CI 3.34-11.94).
  
  
  CONCLUSIONS
  Pre-risk assessment practice may be better at identifying those in need of blood transfusion, strictly due to the necessity for pretransfusion orders for transfusion to occur. In contrast, the obstetric hemorrhage risk assessment accurately predicted those who were more likely to experience hemorrhage outcomes. Optimal utilization of the risk assessment has yet to be determined.
authors.affiliation: Department of Obstetrics and Gynecology, University of California , Irvine, Orange, CA , USA .
authors.forename: Erica
authors.initials: E
authors.lastname: Wu
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Jolley
authors.forename: Brooke A
authors.initials: BA
authors.lastname: Hargrove
authors.forename: Aaron B
authors.initials: AB
authors.lastname: Caughey
authors.forename: Judith H
authors.initials: JH
authors.lastname: Chung
mesh_terms: D000328:Adult; D001803:Blood Transfusion / Q000706:statistics & numerical data; D065187:Controlled Before-After Studies; D005260:Female; D006801:Humans; D006473:Postpartum Hemorrhage; D011247:Pregnancy; D012189:Retrospective Studies; D018570:Risk Assessment; D055815:Young Adult
keywords: Obstetric hemorrhage; pretransfusion testing; risk assessment; transfusion