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Haemorrhage risk score for patients having caesarean section

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Haemorrhage risk score for patients having caesarean sections.

P Kajekar,  S Das*,  E Samuel,  N Bargaje,  R Salma*   

Anaesthetics, Luton and Dunstable hospital, Luton, UK, *Obstetrics, Luton and Dunstable Hospital, Luton, UK 

Introduction:Maternal haemorrhage remains one of the leading causes of maternal mortality and morbidity. Several risk factors are known to increase maternal haemorrhage after caesarean section. We decided to develop a scoring system based on their risk factors which could help predict high risk patients more precisely. Risk reduction strategies can then be used to decrease transfusion and the morbidity related to haemorrhage. 

Methods: Retrospective analysis was done on 100 patients who had caesarean sections in October 2016 after approval from local audit committee. Patient data collected included age, body mass index (BMI), ethnicity and multiparity. Other risk factors like previous haemorrhage, previous caesarean, multiple pregnancy, placental abnormalities, presence of sepsis, big baby were considered. A score was then assigned to each patient. This score was correlated to the actual amount of blood loss during the procedure. Pearsons corelation coefficient was calculated using SPSS software.

Results:100 patients were analysed. Blood loss ranged from 250 ml to 5000 mls with a mean of 824 mls (SD 699). High BMI was found to significantly increase the risk of bleeding. The relationship between haemorrhage risk score and blood loss was investigated using Pearson product-moment correlation coefficient. There was strong, positive correlation between the two variables, r=.654, p<.001, indicating that a high score was associated with a higher bloods loss.

This scoring system can offer a degree of predictability for blood loss in our patients. Based on the scores patients can be classified into low (7 or less), medium (8-15) or high risk ( >15). These patients can then be offered various treatment packages during their antenatal care and caesarean sections consisting of optimisation of haemoglobin (oral or iv iron thearapy), oxytocin infusion, experienced obstetrician and anaesthetist, Cell salvage, Tranexamic acid and other modalities. 

Conclusion: Haemorrhage risk score could be a useful tool to risk stratify patients having a caesarean section. Accordingly attention can be given to various aspects of patient care to improve the quality and safety of care we deliver.

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