Prediction of postpartum hemorrhage in women with gestational hypertension or mild preeclampsia at term. (April 2014)

• Record Type: Journal Article
• Authors: Koopmans, Corine M.; van der, Karin; Groen, Henk; Doornbos, Johannes P.R.; de, Irene M.; van der, Pauline C.M.; Porath, Martina M.; Kuppens, Simone M.I.; Wijnen, Ella J.; Aardenburg, Robert; van, Aren J.; Akerboom, Bettina M.C.; van der, Peggy J.A.; Mol, Ben W.J.; van, Maria G.
• Is Part Of: Acta obstetricia et gynecologica Scandinavica. Volume 93:Number 4(2014)
• Page Start: 399
• Page End: 407
• Publication Date: 2014-04
• Subjects: Gynecology -- Periodicals; Pregnancy -- Periodicals; Obstetrics -- Periodicals; 618.05
• DOI: 10.1111/aogs.12352
• Languages: English
• ISSNs: 0001-6349

Abstract

<abstract abstract-type="main" id="aogs12352-abs-0001"> <title>Abstract</title> <sec id="aogs12352-sec-0001" sec-type="section"> <title>Objective</title> <p>To assess whether postpartum hemorrhage can be predicted in women with gestational hypertension or mild preeclampsia at term.</p> </sec> <sec id="aogs12352-sec-0002" sec-type="section"> <title>Design</title> <p>A cohort study in which we used data from our multicentre randomized controlled trial (HYPITAT trial).</p> </sec> <sec id="aogs12352-sec-0003" sec-type="section"> <title>Setting</title> <p>The study was conducted in 38 hospitals in the Netherlands between 2005 and 2008.</p> </sec> <sec id="aogs12352-sec-0004" sec-type="section"> <title>Population</title> <p>Women with gestational hypertension or mild preeclampsia at term (<italic>n</italic> = 1132).</p> </sec> <sec id="aogs12352-sec-0005" sec-type="section"> <title>Methods</title> <p>An antepartum model (model A) and an antepartum/intrapartum model (model B) were created using logistic regression. The predictive capacity of the models was assessed with receiver operating characteristic analysis and calibration.</p> </sec> <sec id="aogs12352-sec-0006" sec-type="section"> <title>Main outcome measure</title> <p>Postpartum hemorrhage, defined as blood loss >1000 mL within 24 h after delivery.</p> </sec> <sec id="aogs12352-sec-0007" sec-type="section"> <title>Results</title> <p>Postpartum hemorrhage occurred in 118 (10.4%) women. Maternal age (odds ratio 1.03), prepregnancy body mass index (odds ratio 0.96), and women with preeclampsia (odds ratio 1.5) were independent antepartum prognostic variables of postpartum hemorrhage. Intrapartum variables incorporated in the model were gestational age at delivery (odds ratio 1.2), duration of dilatation stage (odds ratio 1.1), and episiotomy (odds ratio 1.5). Model A and model B showed moderate discrimination, with areas under the receiver operating characteristic curve of 0.59 (95% confidence interval 0.53–0.64) and 0.64 (95% confidence interval 0.59–0.70), respectively. Calibration was moderate for model A (Hosmer–Lemeshow <italic>p</italic> = 0.26) but better for model B (Hosmer–Lemeshow <italic>p</italic> = 0.36). The rates of postpartum hemorrhage ranged from 4% (lowest 10%) to 22% (highest 10%).</p> </sec> <sec id="aogs12352-sec-0008" sec-type="section"> <title>Conclusion</title> <p>In the assessment of performance of a prediction model, calibration is more important than discriminative capacity. Our prediction model shows that for women with gestational hypertension or mild preeclampsia at term, distinction between low and high risk of developing postpartum hemorrhage is possible when antepartum and intrapartum variables are combined.</p> </sec> </abstract>