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Obstetric hemorrhage is one of the leading causes of preventable maternal morbidity and mortality worldwide.1 Numerous hemorrhage risk evaluation tools are available; however, there remains a gap in resources and implementation. In a retrospective cohort analysis of multicenter databases including 56,903 women, composite maternal morbidity occurred at a rate of 2.2%, 8%, and 11.9% within low-risk, medium-risk, and high-risk groups, respectively.2 The goal of establishing an evaluation tool for obstetric hemorrhage is to identify patient populations who could benefit from risk-reducing interventions.
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Three published risk-assessment tools include:
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The Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) hemorrhage risk-prediction tool3
The American College of Obstetricians and Gynecologists (ACOG) Safe Motherhood Initiative4
California Maternal Quality Care Collaborative (CMQCC) obstetric hemorrhage risk factor assessment screen1
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Evaluation of obstetric hemorrhage risk is an ongoing process. In our medical center, risk evaluation occurs at admission, during labor, postpartum; current risk (H-score) is presented at “Team Meetings” (Chapter 29, “Whiteboard and Team Meeting”). Understanding that the risk factors can escalate during labor is critical for clinical preparation and management.
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The unique advantage of risk-assessment tool at Beth Israel Deaconess Medical Center (BIDMC) is linked to actions and preparation (Table 34-1).5
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