Development and Validation of Prognostic Nomogram for Postpartum Hemorrhage After Vaginal Delivery: A Retrospective Cohort Study in China

Abstract

BackgroundPostpartum hemorrhage (PPH) is a common complication following vaginal delivery and in severe cases can lead to maternal death. A straightforward predictive model is required to enable prenatal evaluations by obstetricians to prevent PPH complications.MethodsData of patients who delivered vaginally after 37 weeks of gestation were retrospectively collected from the medical database at Shengjing Hospital of China Medical University for the period 2016 to 2020. PPH was defined as blood loss of 500 mL or more within 24 h of delivery, and important independent prognostic factors were determined using univariate and multivariate logistic regression analyses to construct nomograms regarding PPH.ResultsA total of 24,833 patients who delivered vaginally were included in this study. The training cohort included 22,302 patients who delivered between 2016 and 2019 and the external validation cohort included 2,531 patients who delivered during 2020. Nomogram was created using data such as age, race, occupation, parity, gestational weeks, labor time, neonatal weight, analgesic delivery, gestational diabetes mellitus, premature rupture of membranes, anemia, hypertension, adenomyosis, and placental adhesion. The nomogram has good predictive power and clinical practicality through the analysis of the area under the curve and decision curve analysis. Internal verification was performed on the nomogram for PPH, demonstrating consistency between the nomogram's predicted probability and actual probability.ConclusionsThe developed and validatable nomogram is a good predictor of PPH in vaginal delivery and can be used in clinical practice to guide obstetricians to administer preventive therapies before delivery.

A Review of Caesarean Delivery at the Kogi State Specialist Hospital, Lokoja, Nigeria

“…The commonest indication for the CD was obstructed labour in 31.0% of cases. The CD rate of 23% is higher than the ideal CD rate of 10% -15% of the WHO, but is lower than the rising rate of 50% -60% in Dominican Republic and Latin America [13]. There is a global rise of CD rate with Italy reporting 35%, USA 30% and Europe 15% [7].…”

“…Globally, CD rate ranges between 6-27.2% and rises at an average of 4.4% per year [12]. The lowest rates were found in Africa, 7.3%, followed by Asia, 19.2%, Europe 25%, Oceania 31.1% and North America 32.3% with Latin America and Caribbean having the highest rate at 40.5% [12] [13]. The global rising of CD rate may not be far from improved safety from use of antibiotics, blood transfusion services and improved anaesthetic techniques.…”