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. 2011 Nov 28:11:97.
doi: 10.1186/1471-2393-11-97.

Inability to predict postpartum hemorrhage: insights from Egyptian intervention data

Ndola Prata  1 , Sabry Hamza, Suzanne Bell, Deborah Karasek, Farnaz Vahidnia, Martine Holston
Affiliations

Inability to predict postpartum hemorrhage: insights from Egyptian intervention data

Ndola Prata et al. BMC Pregnancy Childbirth. .

Abstract

Background: Knowledge on how well we can predict primary postpartum hemorrhage (PPH) can help policy makers and health providers design current delivery protocols and PPH case management. The purpose of this paper is to identify risk factors and determine predictive probabilities of those risk factors for primary PPH among women expecting singleton vaginal deliveries in Egypt.

Methods: From a prospective cohort study, 2510 pregnant women were recruited over a six-month period in Egypt in 2004. PPH was defined as blood loss ≥ 500 ml. Measures of blood loss were made every 20 minutes for the first 4 hours after delivery using a calibrated under the buttocks drape. Using all variables available in the patients' charts, we divided them in ante-partum and intra-partum factors. We employed logistic regression to analyze socio-demographic, medical and past obstetric history, and labor and delivery outcomes as potential PPH risk factors. Post-model predicted probabilities were estimated using the identified risk factors.

Results: We found a total of 93 cases of primary PPH. In multivariate models, ante-partum hemoglobin, history of previous PPH, labor augmentation and prolonged labor were significantly associated with PPH. Post model probability estimates showed that even among women with three or more risk factors, PPH could only be predicted in 10% of the cases.

Conclusions: The predictive probability of ante-partum and intra-partum risk factors for PPH is very low. Prevention of PPH to all women is highly recommended.

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Figures

Figure 1
Figure 1
Predicted probability for risk factors significantly associated with PPH.
Figure 2
Figure 2
Number of statistically significant risk factors for PPH among women with vaginal deliveries.
Figure 3
Figure 3
Predicted probability of developing PPH according to number of statistically significant risk factors.
Figure 4
Figure 4
ROC for number of risk factors.
See this image and copyright information in PMC

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