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A Framework for Improving Characterization of Obstetric Hemorrhage Using Informatics Data.

Dena Goffman1, Alexander M Friedman, Jean-Ju Sheen

  • 1Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, the Department of Obstetrics and Gynecology, Weill-Cornell Medical Center, and the Value Institute, New York-Presbyterian, New York, New York.

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This study used electronic health records to classify postpartum hemorrhage (PPH) severity. Informatics data enabled granular assessment of PPH trends and outcomes, aiding quality improvement efforts.

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Area of Science:

  • Obstetrics and Gynecology
  • Health Informatics
  • Maternal Health Research

Background:

  • Postpartum hemorrhage (PPH) remains a leading cause of maternal morbidity and mortality.
  • Characterizing PPH severity and trends is crucial for effective clinical management and quality improvement.
  • Electronic health records (EHRs) offer a rich data source for analyzing obstetric outcomes.

Purpose of the Study:

  • To characterize postpartum hemorrhage (PPH) trends and outcomes.
  • To utilize bioinformatics and EHR data for a granular assessment of PPH.
  • To establish a framework for classifying PPH severity based on interventions.

Main Methods:

  • Retrospective analysis of 43,657 deliveries within a four-hospital system (July 2014-July 2017).
  • Development of a four-level PPH classification system based on billing codes and interventions (uterotonics, transfusion, tamponade device, hysterectomy).
  • Analysis of hematocrit drops, treatment patterns (risk-adjusted regression), and severe maternal morbidity in relation to PPH levels.

Main Results:

  • Four PPH levels were defined, affecting 3.7% (Level 1) to 0.6% (Level 4) of patients.
  • Higher PPH levels correlated with greater hematocrit drops; 30.7% of Level 4 patients had >40% drop.
  • Interventions like uterotonics increased significantly, while the risk of hysterectomy decreased significantly (aOR 0.52).

Conclusions:

  • Informatics data allows for detailed characterization of postpartum hemorrhage (PPH) incidence, management, and outcomes.
  • This granular assessment facilitates enhanced surveillance and quality improvement initiatives for PPH.
  • The developed PPH framework provides a valuable tool for understanding and managing severe postpartum bleeding.