Dataset Information

Establishment of a predictive model for postpartum hemorrhage in twins: a retrospective study.

ABSTRACT:

Objective

To explore the risk factors and develop a predictive model for postpartum hemorrhage in twin pregnancies.

Methods

All patients who gave birth at Ningbo Women and Children's Hospital from January 2018 to August 2022 were recruited. Patients were randomly allocated to a training cohort (n[Formula: see text]1395) validation cohort (n[Formula: see text]650) at a 7:3 ratio. In the training cohort, LASSO regression for screening variables and multifactorial logistic regression analysis were performed to identify independent risk factors for postpartum hemorrhage in twin pregnancies. A nomogram was established based on the results of multiple logistic regression analysis. Nomogram performance was quantified using the receiver operating characteristic curve, Hosmer- Lemeshow test and decision curve analysis.

Results

A total of 2045 patients were included in this study. Multifactorial Logistic regression analysis showed maternal age, assisted reproduction, platelet count, fibrinogen level, albumin level, hypertensive disorders of pregnancy, placenta praevia, number of previous cesarean deliveries, number of previous intrauterine manipulation, and neonatal weight were independent risk factors for postpartum hemorrhage in twin births. The area under curve (AUC) for the training cohort was 0.810 [95[Formula: see text] CI (0.781, 0.839)], with a sensitivity of 76.5[Formula: see text], specificity of 71.0[Formula: see text], and positive and negative predictive values of 0.358 and 0.935, respectively, while the AUC for the validation cohort was 0.821 [95[Formula: see text] CI (0.781, 0.860)], with a sensitivity of 80.9[Formula: see text], specificity of 69.49[Formula: see text], and positive predictive value and negative predictive value of 0.426 and 0.929, respectively.

Conclusion

The predictive model can effectively and quantitatively assess the risk of postpartum hemorrhage in twin pregnancies and help clinicians to take personalized preventive measures.

SUBMITTER: Qi S

PROVIDER: S-EPMC10486133 | biostudies-literature | 2023 Sep

REPOSITORIES: biostudies-literature

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Publications

Establishment of a predictive model for postpartum hemorrhage in twins: a retrospective study.

Qi Sangsang S Fu Xianhu X

BMC pregnancy and childbirth 20230907 1

<h4>Objective</h4>To explore the risk factors and develop a predictive model for postpartum hemorrhage in twin pregnancies.<h4>Methods</h4>All patients who gave birth at Ningbo Women and Children's Hospital from January 2018 to August 2022 were recruited. Patients were randomly allocated to a training cohort (n[Formula: see text]1395) validation cohort (n[Formula: see text]650) at a 7:3 ratio. In the training cohort, LASSO regression for screening variables and multifactorial logistic regression ...[more]

PMID: 37679691

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Project description:Background: Postpartum hemorrhage (PPH) is a leading cause of maternal morbidity and mortality worldwide but the incidence and its risk factors in China is limited. The objective of this study is to investigate the incidence and the risk factors of PPH in Chinese women. Methods: A multi-center retrospective study of pregnant women at ≥28 weeks of gestation was conducted. Logistic regression was used to identify potential risk factors of PPH and receiver operating characteristic curve was used to evaluate the predictive performance of the identified risk factors. Subgroup analysis focusing on the number of fetus and the mode of delivery was conducted. Results: A total of 99,253 pregnant women were enrolled and 804 (0.81%) experienced PPH. The subgroup analysis revealed that the incidence of PPH was 0.75, 2.65, 1.40, and 0.31% in singletons, twin pregnancies, cesarean sections, and vaginal deliveries, respectively. Placenta previa and placenta accreta were the predominant risk factors of PPH in the overall population and all subgroups. A twin pregnancy was a risk factor for PPH regardless of the mode of delivery. Obesity, and multiparity were risk factors for PPH in both singletons and cesarean section cases, but the latter predicted a reduced probability of PPH in vaginal deliveries. Macrosomia was associated with increased risk of PPH in singletons or vaginal deliveries. In women who delivered vaginally, preeclampsia was associated with a higher risk of PPH. The areas under the curve for the overall cohort, singletons, twin pregnancies, cesarean section cases, and vaginal deliveries were 0.832 (95% confidence interval [CI] 0.813-0.851), 0.824 (95% CI 0.803-0.845), 0.686 (95% CI 0.617-0.755), 0.854 (95% CI 0.834-0.874), and 0.690 (95% CI 0.646-0.735), respectively. Conclusions: The risk factors of PPH varied slightly based on the number of fetuses and the mode of delivery, while placenta previa and placenta accreta were the two major risk factors. A combination of the identified risk factors yielded a satisfactory predictive performance in determining PPH in the overall cohort, singletons pregnancies, and women who delivered by cesarean section, whereas the performance was moderate in twin pregnancies and in women delivering vaginally.

Project description:Background Pregnant persons with bleeding disorders and their potentially affected newborns are at a higher risk of peripartum bleeding complications. The safest mode of delivery for persons with bleeding disorders remains debated, leading to uncertainties in decision-making between the patient and her multidisciplinary team. Objectives This study aimed to describe maternal outcomes for pregnant persons with bleeding disorders by mode of delivery and to examine whether postpartum hemorrhage (PPH) and neonatal hemorrhagic manifestations are associated with the mode of delivery. Methods We collected retrospective data on pregnant persons with bleeding disorders who delivered at a single center from 2010 to 2021. Descriptive statistics, Fisher exact test, and odds ratios were used for analysis. Results A total of 82 pregnancies in 56 subjects were included. Hemophilia A and von Willebrand disease represented the largest cohort, at 30% (17/56) each. Overall rates of primary and secondary PPH were 7.3% (6/82) and 17.4% (12/69), respectively. We did not find a statistically significant difference between mode of delivery and PPH. Upon comparing vaginal and cesarian deliveries, we found an odds ratio of 0.7 (95% CI, 0.1-3.4) for primary PPH and 2.6 (95% CI, 0.4-16.4) for secondary PPH. One male newborn with severe hemophilia A was treated for a suspected intracranial hemorrhage. Conclusion In our cohort, high rates of PPH remained an important complication for pregnant persons with bleeding disorders. There was no significant difference in PPH based on modes of delivery. The small sample size likely limited the power of our study, and consequently, future larger studies are needed. Essentials • Peripartum management of persons with bleeding disorders requires additional research efforts.• We described maternal and neonatal outcomes from a single Canadian tertiary care center.• Persons with bleeding disorders had high rates of secondary postpartum hemorrhage.• We found no significant difference between rates of postpartum hemorrhage and mode of delivery.

Dataset Information

Establishment of a predictive model for postpartum hemorrhage in twins: a retrospective study.

Objective

Methods

Results

Conclusion

Publications

Establishment of a predictive model for postpartum hemorrhage in twins: a retrospective study.

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