School of Medicine and Health Sciences Poster Presentations

Title

Perinatal Outcomes After Implementing a Hemorrhage Risk Assessment At Admission

Document Type

Poster

Abstract Category

Women/Child Health

Keywords

maternal health, quality improvement, risk assessment

Publication Date

Spring 5-1-2019

Abstract

Our objective was to evaluate the impact of a novel assessment of hemorrhage risk at admission on subsequent perinatal outcomes. This project was a retrospective cohort analysis of a multicenter database included women admitted to labor and delivery from January 2015 to June 2018. A novel nursing assessment developed by Association of Women's Health, Obstetric and Neonatal Nurses was used to categorize patients as low, medium or high risk for hemorrhage. This was implemented 6/1/2016 across the centers. Perinatal outcomes related to blood transfusion, estimated blood loss (EBL) ‚â• 1000cc, ICU admission, chorioamnionitis, general anesthesia, oxytocin use and cesarean delivery were evaluated before and after implementation. There were a total of 109,719 women included, with 38,751 women included prior to implementation of the hemorrhage risk assessment and 70,968 women after implementation. Rates of any blood transfusion (0.5 to 0.4%, p=0.02) and EBL ‚â• 1000cc (6.3 to 6.0%, p=0.02) were significantly lower after implementation. Incidence of ICU admission, chorioamnionitis and general anesthesia did not change overall in the time period studied. There were higher rates of oxytocin use (83.4 to 85.2%, p<0.0001) and spontaneous vaginal delivery (58.8 to 59.9%, p=0.01). Details on perinatal outcomes are included (Table). In conclusion, after implementation of a hemorrhage risk assessment at admission, we found a 20% reduction in rates of blood transfusion and EBL ‚â• 1000cc. Significantly increased oxytocin use was also observed. Further analysis must be done to assess if any other changes could account for these trends.

Open Access

1

Comments

Presented at Research Days 2019.

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Perinatal Outcomes After Implementing a Hemorrhage Risk Assessment At Admission

Our objective was to evaluate the impact of a novel assessment of hemorrhage risk at admission on subsequent perinatal outcomes. This project was a retrospective cohort analysis of a multicenter database included women admitted to labor and delivery from January 2015 to June 2018. A novel nursing assessment developed by Association of Women's Health, Obstetric and Neonatal Nurses was used to categorize patients as low, medium or high risk for hemorrhage. This was implemented 6/1/2016 across the centers. Perinatal outcomes related to blood transfusion, estimated blood loss (EBL) ‚â• 1000cc, ICU admission, chorioamnionitis, general anesthesia, oxytocin use and cesarean delivery were evaluated before and after implementation. There were a total of 109,719 women included, with 38,751 women included prior to implementation of the hemorrhage risk assessment and 70,968 women after implementation. Rates of any blood transfusion (0.5 to 0.4%, p=0.02) and EBL ‚â• 1000cc (6.3 to 6.0%, p=0.02) were significantly lower after implementation. Incidence of ICU admission, chorioamnionitis and general anesthesia did not change overall in the time period studied. There were higher rates of oxytocin use (83.4 to 85.2%, p<0.0001) and spontaneous vaginal delivery (58.8 to 59.9%, p=0.01). Details on perinatal outcomes are included (Table). In conclusion, after implementation of a hemorrhage risk assessment at admission, we found a 20% reduction in rates of blood transfusion and EBL ‚â• 1000cc. Significantly increased oxytocin use was also observed. Further analysis must be done to assess if any other changes could account for these trends.