Criteria for severe obstetric hemorrhage - one or both of the following:
(1) estimated blood loss > 1,500 mL from onset of delivery to 24 hours postpartum
(2) postpartum blood transfusion for obstetrical hemorrhage
Women with severe obstetrical hemorrhage were at greater risk for:
(1) ICU admission
(2) hysterectomy
(3) postpartum sepsis
(4) acute renal failure
(5) death
Risk factors for severe hemorrhage (adjusted odds ratio > 1.4 on multivariate analysis):
(1) South-East Asian ethnicity
(2) age >= 40 years of age
(3) multiple pregnancies
(4) von Willebrand's disease or other coagulopathy
(5) hemoglobin < 9 g/dL during pregnancy
(6) Caesarean section (emergency greater than elective)
(7) uterine atony without retained secundines
(8) retained secundines
(9) trauma
(10) abruption
(11) placenta praevia
(12) birth weight >= 4.5 kg
(13) delivery using forceps or vacuum
(14) induced labor
(15) history of previous Caesarean delivery
(16) maternal heart disease
(17) HELLP syndrome
Factors associated with reduced risk:
(1) Middle-Eastern ancestry
In the implementation a total score is used based on the number of risk factors present, with some weighted.
