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Predicting risk of postpartum haemorrhage: a systematic review
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  • Charlotte Neary,
  • David McLernon,
  • Sanobar Naheed,
  • Mairead Black
Charlotte Neary
Royal Hospital for Children Glasgow
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David McLernon
Sch Med
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Sanobar Naheed
Aberdeen Maternity Hospital
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Mairead Black
Aberdeen Maternity Hospital
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Abstract

Background: Postpartum haemorrhage (PPH) rates are increasing in developed countries. A reliable prognostic tool for PPH has potential to aid prevention efforts. Objective: To systematically identify and appraise prognostic modelling studies for prediction of PPH. Search strategy: MEDLINE, Embase, CINAHL and the Cochrane Library were searched using a combination of terms and synonyms including ‘prediction tool’, ‘risk score’ and ‘postpartum haemorrhage’. Selection criteria: Any observational or experimental study developing a prognostic model for women’s risk of PPH. English language publications. Data collection and analysis: Predesigned data extraction form to record: data source; participant criteria; outcome; candidate predictors; actual predictors; sample size; missing data; model development; model performance; model evaluation; interpretation. Main Results: Of 1723 citations screened, 10 studies were eligible for inclusion. An additional paper was published and identified following completion of the search. Studies addressed populations of women who experienced; placenta praevia; vaginal births; caesarean birth; and the general obstetric population. Primary study authors deemed four models to be confirmatory. There was a high risk of bias across all studies due to a combination of retrospective selection of women, low sample size, no internal validation, suboptimal external validation and no reporting of missing data. Conclusion: Of eleven prognostic models for PPH risk, one developed for women undergoing caesarean section is deemed suitable for external validation. Future research requires robust internal and external validation of existing tools and development of a model that can be used to predict PPH in the general obstetric population. Protocol registration number: PROSPERO 95587

Peer review status:ACCEPTED

06 Mar 2020Submitted to BJOG: An International Journal of Obstetrics and Gynaecology
19 Mar 2020Submission Checks Completed
19 Mar 2020Assigned to Editor
20 Mar 2020Reviewer(s) Assigned
03 Apr 2020Review(s) Completed, Editorial Evaluation Pending
28 Apr 2020Editorial Decision: Revise Major
04 Jun 20201st Revision Received
08 Jun 2020Submission Checks Completed
08 Jun 2020Assigned to Editor
11 Jun 2020Editorial Decision: Accept