196526 How well can we predict postpartum hemorrhage? Insights from Egyptian data

Monday, November 9, 2009: 9:05 AM

Ndola Prata, MD, MSc , The Bixby Center for Population, Health and Sustainability, School of Public Health, University of California, Berkeley, Berkeley, CA
Deborah Karasek, MPH , Advancing New Standards in Reproductive Health; Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, Oakland, CA
Farnaz Vahidnia, MD, MPH , University of California, Berkeley, Berkeley, CA
Sabry Hamza, MD , Health System Strengthening Project, Abt Associate Inc Jordan, Amman, Jordan
Martine Holston, MPH , Venture Strategies Innovations, Berkeley, CA
Postpartum hemorrhage (PPH), the main cause of maternal death, is difficult to predict. Currently, no accurate screening tools exist to guide healthcare workers in identifying women who would develop PPH. This paper aims to identify risk factors for PPH and determine their predictive probability. We collected data on 2510 women with anticipated singleton vaginal delivery and gestational age greater than 36 weeks over six months in 2004 in obstetrical units of three Egyptian university hospitals.

Blood loss was measured every 20 minutes for the first four hours after delivery using a calibrated under the buttocks drape. We defined the main outcome, incidence of PPH, as blood loss > 500mL. Using logistic regression, we analyzed socio-demographic, medical and past obstetric history, and labor and delivery events as potential PPH risk factors.

93 cases of primary PPH were recorded. In multivariate models, antepartum hemoglobin, history of previous PPH, labor augmentation, and prolonged labor were significantly associated with PPH. Post-model predictive probability estimates showed that, to predict PPH significantly, presentation of at least three risk factors is required. However, screening of women with three or more risk factors would only predict 10% of PPH cases.

The predictive probability of antepartum and intrapartum risk factors for PPH is very low. No single risk factor or combination of risk factors can reliably predict risk of PPH. Knowledge on the accuracy of predicting primary PPH will help redesign delivery protocols and PPH case management. Due to low predictability, prevention of PPH is recommended for all women.

Learning Objectives:
1.List and define the main risk factors for PPH. 2.Discuss the predictive value of risk factors to predict PPH, and the accuracy of these predictions. 3.Identify the implications of predicting PPH using risk factors, and the predictive probability of these risk factors, on delivery practices and PPH case management.

Keywords: Maternal Morbidity, Risk Factors

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I received my MPH in Epidemiology at the University of California, Berkeley and participated in the analysis and writing of this paper.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.