Title:
Charlotte Neary, NHS Greater Glasgow and Clyde, Paediatric Surgery,
Royal Hospital for Children in Glasgow, 1345 Govan Road Glasgow G51 4TF
Sanobar Naheed, NHS Grampian, Department of Obstetrics and Gynaecology,
Aberdeen Maternity hospital, Cornhill Road, Aberdeen, AB252ZD
David J McLernon, Department of Medical Statistics, Institute of Applied
Health Sciences, University of Aberdeen, Polwarth Building, Cornhill
Road, Aberdeen, AB252ZD
Mairead Black, Aberdeen Centre for Women’s Health Research, University
of Aberdeen, Room 4, Second Floor, Aberdeen Maternity hospital, Cornhill
Road, Aberdeen, AB252ZD, 01224 438437, Mairead.black@abdn.ac.uk
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.
Systematic review registration number: PROSPERO 95587
Tweetable abstract
Current PPH prediction tools need external validation: One for CS; one
for placenta praevia. Tools are needed for labouring women.