Predictive value of thyroid hormone levels for postpartum hemorrhage in hypothyroidism-complicated pregnancy

To explore the predictive value of thyroid hormone (TH) related indices for postpartum hemorrhage (PPH) in pregnant women with hypothyroidism-complicated pregnancy (HCP).

273 pregnant women with HCP admitted to our hospital from January 2021 to December 2024 were retrospectively selected. The patients were divided into PPH group (n=50) and non-PPH group (n=223) based on whether PPH occurred. The influencing factors were analyzed with univariate and Binary logistic regression analysis. The receiver operating characteristic (ROC) curve was used to evaluate the predictive value of TH related indices for PPH in pregnant women with HCP.

There were statistically significant differences in manual placental removal, delivery conditions, fetal weight >4000g, TSH, and FT4 (P < 0.05). The results of Binary logistic regression analysis showed that delivery conditions, TSH, and FT4 were independent influencing factors for PPH in pregnant women with HCP (P < 0.05). The ROC analysis results showed that the area under the curve for TSH+FT4 was 0.823, with a standard error of 0.032 (95% CI: 0.761~0.886), Youden index=0.48, sensitivity of 66.00%, and specificity of 81.61%. Patients with high TSH and low FT4 levels had lower Apgar scores for newborns and higher rates of postpartum hemorrhage.

TSH and FT4 have certain value in predicting PPH in pregnant women with HCP, and it is recommended to include them in predictive indices/models.