Predictive value of a bleeding score for postpartum hemorrhage

Gillissen, A.; Akker, T. van den; Caram-Deelder, C.; Henriquez, D.D.C.A.; Bijvank, S.W.A.N.; Bloemenkamp, K.W.M.; ... ; Bom, J.G. van der (2019)

Article / Letter to editor

Background: A reliable screening tool that could contribute to the identification of women with an increased risk of postpartum hemorrhage would be of great clinical significance.Objectives: The aim of this study was to examine the added predictive value of a bleeding assessment tool for postpartum hemorrhage exceeding 1000mL.Patients/Methods: Prospective two-center cohort study among 1147 pregnant women visiting the outpatient clinic or the maternity ward who completed a bleeding assessment tool prior to birth. The condensed MCMDM-1VWD bleeding assessment tool was adjusted to a questionnaire that could be used as a self-assessment bleeding tool. A score of 4 was considered to be abnormal.Results: In the 1147 pregnant women in our cohort, bleeding scores ranged from -3 to 13, with a median of 1 (IQR -1 to 3); 197 (17%) women developed postpartum hemorrhage. Among women with a history of postpartum hemorrhage 29% developed postpartum hemorrhage. Among 147 women with an abnormal bleeding score (4), 27 (18%) developed postpartum hemorrhage, whereas the remaining 170 cases of postpartum hemorrhage had a normal bleeding score. Despite the high incidence of postpartum hemorrhage, the ability of the bleeding score to predict postpartum hemorrhage was poor: area under receiver operating curve 0.53 (95% CI 0.49-0.58) for postpartum hemorrhage (PPH) 1000mL.Conclusions: A history of significant postpartum hemorrhage was associated with an increased risk of subsequent postpartum hemorrhage. However, screening with a bleeding assessment tool did not help to discriminate women who will develop postpartum hemorrhage from women who will not.

• bleeding assessment tool
• bleeding score
• postpartum hemorrhage
• prediction
• pregnancy

• All authors: Gillissen, A.; Akker, T. van den; Caram-Deelder, C.; Henriquez, D.D.C.A.; Bijvank, S.W.A.N.; Bloemenkamp, K.W.M.; Eikenboom, J.; Bom, J.G. van der
• Date: 2019-04-01
• Journal: Research and Practice in Thrombosis and Haemostasis
• Volume: 3
• Issue: 2
• Pages: 277 - 284
• DOI: doi:10.1002/rth2.12194