Probability of severe postpartum hemorrhage in repeat cesarean
deliveries: a multicenter retrospective study in China
Abstract
Objective: The aim of this study was to determine the factors predicting
the probability of severe postpartum hemorrhage in women undergoing
repeat cesarean delivery. Design: This multicenter, retrospective cohort
study based on data from 11 public tertiary hospitals within 7 provinces
of China. Setting: 11 public tertiary hospitals within 7 provinces of
China. Population: 11074 eligible pregnant women who had a history of
cesarean delivery and undergo cesarean delivery again after 28 weeks of
gestation. Methods: The cohort was divided into the development and
validation sets. The all-variables model and the multivariable logistic
regression model (simple model) were fitted to estimate the probability
of severe postpartum hemorrhage. Results: Six independent risk factors
of severe postpartum hemorrhage in the simple model were selected from
40 clinical information features including a history of endometrial
injury, complications with placenta previa or placenta accreta, lower
gestational age at delivery, pelvic adhesion, and previous uterine
incision status. Our final simple model showed excellent discrimination
and calibration, with areas under the ROC curve of more than 0.90 in the
validation set. Conclusions: Predictive tools based on patient clinical
characteristics can be used to accurately estimate the probability of
severe postpartum hemorrhage in patients undergoing repeat cesarean
delivery. Funding National Key R&D Program of China (No. 2016YFC1000405
and 2017YFC1001402) and the National Natural Science Foundation (No.
81830045, 81671533 and 81571518). Keywords repeat cesarean deliveries;
severe postpartum hemorrhage; placenta previa; placenta accrete; pelvic
adhesion; prediction; obstetrics