Inability to predict postpartum hemorrhage: insights from Egyptian intervention data

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

doi:10.1186/1471-2393-11-97

Abstract

BackgroundKnowledge 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.MethodsFrom 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.ResultsWe 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.ConclusionsThe predictive probability of ante-partum and intra-partum risk factors for PPH is very low. Prevention of PPH to all women is highly recommended.

Highlights

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 secondary objective of this study is to identify the components of active management of the third stage of labor (AMTSL) that have the greatest impact on PPH incidence
Odds ratios from bivariable analyses of risk factors and incidence of PPH are reported along with associated p-values and 95% confidence intervals (CIs)

Summary

Introduction

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. Risk factors in the intra-partum period may provide opportunity for intervention, or for active management in the early stages of PPH. Despite the severe burden of PPH, few studies have examined risk factors predicting PPH in developing countries. The primary objective of this study is to investigate the ability to predict PPH by early screening of Previous Research Previous research has identified demographic, ante-partum, and intra-partum risk factors that are associated with risk of hemorrhage, but these associations are not predictive. All of the risk factors found are described below; citations are only for the most recent article published on the topic

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