In the United States, postpartum hemorrhage is a leading preventable cause of maternal mortality and morbidity. To reduce morbidity from postpartum hemorrhage, risk assessment is an important starting point for informing decisions about risk management and hemorrhage prevention. Current perinatal care guidelines from the Joint Commission recommend that all patients undergo postpartum hemorrhage risk assessment at admission and after delivery. Three maternal health organizations-the California Maternal Quality Care Collaborative, AWHONN, and the American College of Obstetricians and Gynecologists' Safe Motherhood Initiative-have developed postpartum hemorrhage risk-assessment tools for clinical use. Based on the presence of risk factors, each organization categorizes patients as low-, medium-, or high-risk, and ties pretransfusion testing recommendations to these categorizations. However, the accuracy of these tools' risk categorizations has come under increasing scrutiny. Given their low positive predictive value, the value proposition of pretransfusion testing in all patients classified as medium- and high-risk is low. Further, 40% of all postpartum hemorrhage events occur in low-risk patients, emphasizing the need for early vigilance and treatment regardless of categorization. We recommend that maternal health organizations consider alternatives to category-based risk tools for evaluating postpartum hemorrhage risk before delivery.

中文翻译：

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产后出血风险评估的现状和未来方向。

在美国，产后出血是孕产妇死亡和发病的一个可预防的主要原因。为了降低产后出血的发病率，风险评估是制定风险管理和出血预防决策的重要起点。联合委员会当前的围产期护理指南建议所有患者在入院和分娩后接受产后出血风险评估。三个孕产妇保健组织——加州孕产妇质量护理合作组织、AWHONN 和美国妇产科医师学会的安全孕产倡议——已经开发了供临床使用的产后出血风险评估工具。根据风险因素的存在，每个组织将患者分为低风险、中风险或高风险，并将输血前检测建议与这些分类联系起来。然而，这些工具风险分类的准确性受到越来越多的审查。鉴于其阳性预测值较低，所有被分类为中危和高危患者的输血前检测的价值主张较低。此外，40% 的产后出血事件发生在低风险患者中，这强调了无论分类如何，都需要早期警惕和治疗。我们建议孕产妇保健组织考虑使用基于类别的风险工具的替代方案来评估产前出血风险。对所有中危和高危患者进行输血前检测的价值主张较低。此外，40% 的产后出血事件发生在低风险患者中，这强调了无论分类如何，都需要早期警惕和治疗。我们建议孕产妇保健组织考虑使用基于类别的风险工具的替代方案来评估产前出血风险。对所有中危和高危患者进行输血前检测的价值主张较低。此外，40% 的产后出血事件发生在低风险患者中，这强调了无论分类如何，都需要早期警惕和治疗。我们建议孕产妇保健组织考虑使用基于类别的风险工具的替代方案来评估产前出血风险。