A Framework for Improving Characterization of Obstetric Hemorrhage Using Informatics Data

Abstract

ICD-10-CM O720 Third-stage hemorrhage O721 Other immediate postpartum hemorrhage O722 Delayed and secondary postpartum hemorrhage ICD-9-CM 66600 Third-stage postpartum hemorrhage, unspecified as to episode of care or not applicable 66602 Third-stage postpartum hemorrhage, delivered, with mention of postpartum complication 66604 Third-stage postpartum hemorrhage, postpartum condition or complication 66610 Other immediate postpartum hemorrhage, unspecified as to episode of care or not applicable 66612 Other immediate postpartum hemorrhage, delivered, with mention of postpartum complication 66614 Other immediate postpartum hemorrhage, postpartum condition or complication 66620 Delayed and secondary postpartum hemorrhage, unspecified as to episode of care or not applicable 66622 Delayed and secondary postpartum hemorrhage, delivered, with mention of postpartum complication 66624 Delayed and secondary postpartum hemorrhage, postpartum condition or complication Bakri balloon (PPH level 3) EMR notes n/a Any EMR note that contains the term 'Bakri' Goffman D, Friedman AM, Sheen JJ, Kessler A, Vawdrey D, Green R, et al. A framework for improving characterization of obstetric hemorrhage using informatics data. Obstet Gynecol 2019;134.The authors provided this information as a supplement to their article.

Intrauterine Vacuum-Induced Hemorrhage-Control Device for Rapid Treatment of Postpartum Hemorrhage

“…Large state-wide perinatal-quality collaboratives continue to cite blood loss greater than 500–999 mL as abnormal, 18 , 19 and care teams often initiate treatment in this abnormal range to minimize ongoing blood loss. 3 Exclusion criteria included retained placenta without easy manual removal, uterine rupture, purulent infection, coagulopathy, or blood loss greater than 1,500 mL at time of device placement. Additional medications could be continued during or after treatment according to standard care at each clinical site, provided maximum dosing was not exceeded.…”

“… 1 Moreover, the problem is growing, particularly in the United States, where rates of severe maternal morbidity and transfusions have increased 2 despite commensurately increasing utilization rates of first- and second-line postpartum hemorrhage treatment modalities. 3 Many important efforts have been developed to address these trends, notably comprehensive safety bundles inclusive of recognition and prevention of abnormal postpartum bleeding, readiness with improved training and transfusion protocols, and robust quality reporting, 4 – 6 and yet there have been few innovative approaches to treat abnormal postpartum bleeding or postpartum hemorrhage before morbidity occurs.…”

A comprehensive digital phenotype for postpartum hemorrhage

“…More recently, in an effort to standardize clinical obstetric definitions, the American College of Obstetricians and Gynecologists (ACOG) developed the reVITALize program, which defines postpartum hemorrhage as a cumulative blood loss of greater than or equal 1000mL or blood loss accompanied by signs or symptoms of hypovolemia within 24 hours following delivery (including intrapartum blood loss)[24]. However, blood loss is still most commonly estimated visually and this measure is central to diagnosis and initiation of treatment[4,6], as well as the primary metric used retrospectively for hospital quality outcomes and research aimed at improving prevention and treatment of PPH[15]. Overreliance on estimated blood loss (EBL) alone has contributed to underestimation of hemorrhage[17,19,20,22,23,25]; this is a key area for improvement in PPH prevention efforts.…”

“…The use of QBL can lead to earlier interventions and a greater emphasis on attention to blood loss, though these practices have not been widely adopted since they require hospitals to have specialized equipment and training for providers[6,21]. Additionally, while quantitative measures are more accurate than visual estimates, they can still be imprecise, as well as variable across caregivers[15,27]. Furthermore, this threshold is necessarily arbitrary and some women needing care for hemorrhage may ultimately lose less than 1000mL[23].…”

“…A proxy measure of blood loss is change in hematocrit values, with a 10% drop indicating PPH[1], although this may have low specificity and is affected by global changes in fluids like dehydration or any infusions[21]. Alternatively, PPH can also be indexed with diagnostic codes or with indications of severe outcomes like blood transfusions or surgical interventions[15,28]. However, diagnostic codes have low sensitivity[16], while indications of severe outcomes have high sensitivity, but occur in a minority of cases.…”