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Probability of severe postpartum hemorrhage in repeat cesarean deliveries: a multicenter retrospective study in China
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  • Lili Du,
  • Ling Feng,
  • Shilei Bi,
  • Lizi Zhang,
  • Jingman Tang,
  • Liuying Zhong,
  • Xingnan Zhou,
  • Lijun Huang,
  • Lin Lin,
  • Shanshan Zeng,
  • Luwen Ren,
  • Yinli Cao,
  • Jinping Jia,
  • Xianlan Zhao,
  • Shaoshuai Wang,
  • Xiaoyan Xu,
  • Yangyu Zhao,
  • Zhijian Wang,
  • Qiying Zhu,
  • Hongbo Qi,
  • Lanzhen Zhang,
  • Suiwen Wen,
  • Hongtian Li,
  • Jingsi Chen,
  • Dunjin Chen
Lili Du
Third Affiliated Hospital of Guangzhou Medical University
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Ling Feng
Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology
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Shilei Bi
Third Affiliated Hospital of Guangzhou Medical University
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Lizi Zhang
Southern Medical University Nanfang Hospital
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Jingman Tang
Third Affiliated Hospital of Guangzhou Medical University
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Liuying Zhong
Third Affiliated Hospital of Guangzhou Medical University
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Xingnan Zhou
Third Affiliated Hospital of Guangzhou Medical University
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Lijun Huang
Third Affiliated Hospital of Guangzhou Medical University
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Lin Lin
Third Affiliated Hospital of Guangzhou Medical University
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Shanshan Zeng
Third Affiliated Hospital of Guangzhou Medical University
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Luwen Ren
Third Affiliated Hospital of Guangzhou Medical University
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Yinli Cao
Department of Obstetrics and Gynecology, Northwest Women’s and Children’s Hospital
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Jinping Jia
Department of Obstetrics and Gynecology, Guangzhou Huadu District Maternal and Child Health Hospital
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Xianlan Zhao
Department of Obstetrics and Gynecology, The First Affiliated Hospital of Zhengzhou University
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Shaoshuai Wang
Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology
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Xiaoyan Xu
Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology
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Yangyu Zhao
Peking University Third Hospital
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Zhijian Wang
Southern Medical University Nanfang Hospital
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Qiying Zhu
Xinjiang Medical University Affiliated First Hospital
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Hongbo Qi
Department of Obstetrics and Gynecology, The First Affiliated Hospital of Chongqing Medical University
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Lanzhen Zhang
Guangzhou Medical University Second Affiliated Hospital
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Suiwen Wen
The Sixth Affiliated Hospital of Guangzhou Medical University
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Hongtian Li
Peking University Health Science Center
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Jingsi Chen
Third Affiliated Hospital of Guangzhou Medical University
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Dunjin Chen
Third Affiliated Hospital of Guangzhou Medical University
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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