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Identifying women most likely to benefit from prevention strategies for postpartum hemorrhage
1Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90033, USA.
Objective:
To identify women who are most likely to benefit from primary prevention strategies for postpartum hemorrhage (PPH).
Study Design:
In a retrospective patient cohort, we applied recursive partitioning algorithms to identify the most discriminant risk factors and their interactions, and calculated the 'number needed to treat' to prevent a single case of PPH (estimated blood loss >1000 ml).
Result:
By delivery category, the highest risk groups with 'number needed to treat' ranging from 4 to 7 were: (1) vaginal delivery (PPH=0.7% of 16 218)-macrosomia with gestational diabetes and manual removal of the placenta; (2) primary cesarean (PPH=18.7% of 2696)-macrosomia and multiparity; and (3) repeat cesarean (PPH=16.0% of 1832)-uterine incision other than low transverse and failed vaginal birth after cesarean.
Conclusion:
Clinical profiles that identify women at risk for PPH can provide a foundation for the development of primary prevention strategies.
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