Prediction of postpartum hemorrhage in women with gestational hypertension or mild preeclampsia at term

Corine M. Koopmans; Karin Van Der Tuuk; Henk Groen; Johannes P.R. Doornbos; Irene M. De Graaf; Pauline C.M. Van Der Salm; Martina M. Porath; Simone M.I. Kuppens; Ella J. Wijnen; Robert Aardenburg; Aren J. Van Loon; Bettina M.C. Akerboom; Peggy J.A. Van Der Lans; Ben W.J. Mol; Maria G. Van Pampus

doi:10.1111/aogs.12352

Prediction of postpartum hemorrhage in women with gestational hypertension or mild preeclampsia at term

Corine M. Koopmans, Karin Van Der Tuuk, Henk Groen, Johannes P.R. Doornbos, Irene M. De Graaf, Pauline C.M. Van Der Salm, Martina M. Porath, Simone M.I. Kuppens, Ella J. Wijnen, Robert Aardenburg, Aren J. Van Loon, Bettina M.C. Akerboom, Peggy J.A. Van Der Lans, Ben W.J. Mol, Maria G. Van Pampus

Research output: Contribution to journal › Article › peer-review

36 Citations (Scopus)

Abstract

Objective To assess whether postpartum hemorrhage can be predicted in women with gestational hypertension or mild preeclampsia at term. Design A cohort study in which we used data from our multicentre randomized controlled trial (HYPITAT trial). Setting The study was conducted in 38 hospitals in the Netherlands between 2005 and 2008. Population Women with gestational hypertension or mild preeclampsia at term (n = 1132). Methods An antepartum model (model A) and an antepartum/intrapartum model (model B) were created using logistic regression. The predictive capacity of the models was assessed with receiver operating characteristic analysis and calibration. Main outcome measure Postpartum hemorrhage, defined as blood loss >1000 mL within 24 h after delivery. Results Postpartum hemorrhage occurred in 118 (10.4%) women. Maternal age (odds ratio 1.03), prepregnancy body mass index (odds ratio 0.96), and women with preeclampsia (odds ratio 1.5) were independent antepartum prognostic variables of postpartum hemorrhage. Intrapartum variables incorporated in the model were gestational age at delivery (odds ratio 1.2), duration of dilatation stage (odds ratio 1.1), and episiotomy (odds ratio 1.5). Model A and model B showed moderate discrimination, with areas under the receiver operating characteristic curve of 0.59 (95% confidence interval 0.53-0.64) and 0.64 (95% confidence interval 0.59-0.70), respectively. Calibration was moderate for model A (Hosmer-Lemeshow p = 0.26) but better for model B (Hosmer-Lemeshow p = 0.36). The rates of postpartum hemorrhage ranged from 4% (lowest 10%) to 22% (highest 10%). Conclusion In the assessment of performance of a prediction model, calibration is more important than discriminative capacity. Our prediction model shows that for women with gestational hypertension or mild preeclampsia at term, distinction between low and high risk of developing postpartum hemorrhage is possible when antepartum and intrapartum variables are combined.

Original language	English
Pages (from-to)	399-407
Number of pages	9
Journal	Acta Obstetricia et Gynecologica Scandinavica
Volume	93
Issue number	4
DOIs	https://doi.org/10.1111/aogs.12352
Publication status	Published or Issued - Apr 2014
Externally published	Yes

Keywords

Preeclampsia
calibration
gestational hypertension
predictive value
prognostic model
receiver-operating characteristic curve analysis

ASJC Scopus subject areas

Obstetrics and Gynaecology

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10.1111/aogs.12352

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Koopmans, C. M., Van Der Tuuk, K., Groen, H., Doornbos, J. P. R., De Graaf, I. M., Van Der Salm, P. C. M., Porath, M. M., Kuppens, S. M. I., Wijnen, E. J., Aardenburg, R., Van Loon, A. J., Akerboom, B. M. C., Van Der Lans, P. J. A., Mol, B. W. J., & Van Pampus, M. G. (2014). Prediction of postpartum hemorrhage in women with gestational hypertension or mild preeclampsia at term. Acta Obstetricia et Gynecologica Scandinavica, 93(4), 399-407. https://doi.org/10.1111/aogs.12352

@article{26fa28e3ea8244439eea76be9ae7ae2b,

title = "Prediction of postpartum hemorrhage in women with gestational hypertension or mild preeclampsia at term",

abstract = "Objective To assess whether postpartum hemorrhage can be predicted in women with gestational hypertension or mild preeclampsia at term. Design A cohort study in which we used data from our multicentre randomized controlled trial (HYPITAT trial). Setting The study was conducted in 38 hospitals in the Netherlands between 2005 and 2008. Population Women with gestational hypertension or mild preeclampsia at term (n = 1132). Methods An antepartum model (model A) and an antepartum/intrapartum model (model B) were created using logistic regression. The predictive capacity of the models was assessed with receiver operating characteristic analysis and calibration. Main outcome measure Postpartum hemorrhage, defined as blood loss >1000 mL within 24 h after delivery. Results Postpartum hemorrhage occurred in 118 (10.4%) women. Maternal age (odds ratio 1.03), prepregnancy body mass index (odds ratio 0.96), and women with preeclampsia (odds ratio 1.5) were independent antepartum prognostic variables of postpartum hemorrhage. Intrapartum variables incorporated in the model were gestational age at delivery (odds ratio 1.2), duration of dilatation stage (odds ratio 1.1), and episiotomy (odds ratio 1.5). Model A and model B showed moderate discrimination, with areas under the receiver operating characteristic curve of 0.59 (95% confidence interval 0.53-0.64) and 0.64 (95% confidence interval 0.59-0.70), respectively. Calibration was moderate for model A (Hosmer-Lemeshow p = 0.26) but better for model B (Hosmer-Lemeshow p = 0.36). The rates of postpartum hemorrhage ranged from 4% (lowest 10%) to 22% (highest 10%). Conclusion In the assessment of performance of a prediction model, calibration is more important than discriminative capacity. Our prediction model shows that for women with gestational hypertension or mild preeclampsia at term, distinction between low and high risk of developing postpartum hemorrhage is possible when antepartum and intrapartum variables are combined.",

keywords = "Preeclampsia, calibration, gestational hypertension, predictive value, prognostic model, receiver-operating characteristic curve analysis",

author = "Koopmans, {Corine M.} and {Van Der Tuuk}, Karin and Henk Groen and Doornbos, {Johannes P.R.} and {De Graaf}, {Irene M.} and {Van Der Salm}, {Pauline C.M.} and Porath, {Martina M.} and Kuppens, {Simone M.I.} and Wijnen, {Ella J.} and Robert Aardenburg and {Van Loon}, {Aren J.} and Akerboom, {Bettina M.C.} and {Van Der Lans}, {Peggy J.A.} and Mol, {Ben W.J.} and {Van Pampus}, {Maria G.}",

year = "2014",

month = apr,

doi = "10.1111/aogs.12352",

language = "English",

volume = "93",

pages = "399--407",

journal = "Acta Obstetricia et Gynecologica Scandinavica",

issn = "0001-6349",

publisher = "Wiley-Blackwell",

number = "4",

}

Koopmans, CM, Van Der Tuuk, K, Groen, H, Doornbos, JPR, De Graaf, IM, Van Der Salm, PCM, Porath, MM, Kuppens, SMI, Wijnen, EJ, Aardenburg, R, Van Loon, AJ, Akerboom, BMC, Van Der Lans, PJA, Mol, BWJ & Van Pampus, MG 2014, 'Prediction of postpartum hemorrhage in women with gestational hypertension or mild preeclampsia at term', Acta Obstetricia et Gynecologica Scandinavica, vol. 93, no. 4, pp. 399-407. https://doi.org/10.1111/aogs.12352

TY - JOUR

T1 - Prediction of postpartum hemorrhage in women with gestational hypertension or mild preeclampsia at term

AU - Koopmans, Corine M.

AU - Van Der Tuuk, Karin

AU - Groen, Henk

AU - Doornbos, Johannes P.R.

AU - De Graaf, Irene M.

AU - Van Der Salm, Pauline C.M.

AU - Porath, Martina M.

AU - Kuppens, Simone M.I.

AU - Wijnen, Ella J.

AU - Aardenburg, Robert

AU - Van Loon, Aren J.

AU - Akerboom, Bettina M.C.

AU - Van Der Lans, Peggy J.A.

AU - Mol, Ben W.J.

AU - Van Pampus, Maria G.

PY - 2014/4

Y1 - 2014/4

N2 - Objective To assess whether postpartum hemorrhage can be predicted in women with gestational hypertension or mild preeclampsia at term. Design A cohort study in which we used data from our multicentre randomized controlled trial (HYPITAT trial). Setting The study was conducted in 38 hospitals in the Netherlands between 2005 and 2008. Population Women with gestational hypertension or mild preeclampsia at term (n = 1132). Methods An antepartum model (model A) and an antepartum/intrapartum model (model B) were created using logistic regression. The predictive capacity of the models was assessed with receiver operating characteristic analysis and calibration. Main outcome measure Postpartum hemorrhage, defined as blood loss >1000 mL within 24 h after delivery. Results Postpartum hemorrhage occurred in 118 (10.4%) women. Maternal age (odds ratio 1.03), prepregnancy body mass index (odds ratio 0.96), and women with preeclampsia (odds ratio 1.5) were independent antepartum prognostic variables of postpartum hemorrhage. Intrapartum variables incorporated in the model were gestational age at delivery (odds ratio 1.2), duration of dilatation stage (odds ratio 1.1), and episiotomy (odds ratio 1.5). Model A and model B showed moderate discrimination, with areas under the receiver operating characteristic curve of 0.59 (95% confidence interval 0.53-0.64) and 0.64 (95% confidence interval 0.59-0.70), respectively. Calibration was moderate for model A (Hosmer-Lemeshow p = 0.26) but better for model B (Hosmer-Lemeshow p = 0.36). The rates of postpartum hemorrhage ranged from 4% (lowest 10%) to 22% (highest 10%). Conclusion In the assessment of performance of a prediction model, calibration is more important than discriminative capacity. Our prediction model shows that for women with gestational hypertension or mild preeclampsia at term, distinction between low and high risk of developing postpartum hemorrhage is possible when antepartum and intrapartum variables are combined.

AB - Objective To assess whether postpartum hemorrhage can be predicted in women with gestational hypertension or mild preeclampsia at term. Design A cohort study in which we used data from our multicentre randomized controlled trial (HYPITAT trial). Setting The study was conducted in 38 hospitals in the Netherlands between 2005 and 2008. Population Women with gestational hypertension or mild preeclampsia at term (n = 1132). Methods An antepartum model (model A) and an antepartum/intrapartum model (model B) were created using logistic regression. The predictive capacity of the models was assessed with receiver operating characteristic analysis and calibration. Main outcome measure Postpartum hemorrhage, defined as blood loss >1000 mL within 24 h after delivery. Results Postpartum hemorrhage occurred in 118 (10.4%) women. Maternal age (odds ratio 1.03), prepregnancy body mass index (odds ratio 0.96), and women with preeclampsia (odds ratio 1.5) were independent antepartum prognostic variables of postpartum hemorrhage. Intrapartum variables incorporated in the model were gestational age at delivery (odds ratio 1.2), duration of dilatation stage (odds ratio 1.1), and episiotomy (odds ratio 1.5). Model A and model B showed moderate discrimination, with areas under the receiver operating characteristic curve of 0.59 (95% confidence interval 0.53-0.64) and 0.64 (95% confidence interval 0.59-0.70), respectively. Calibration was moderate for model A (Hosmer-Lemeshow p = 0.26) but better for model B (Hosmer-Lemeshow p = 0.36). The rates of postpartum hemorrhage ranged from 4% (lowest 10%) to 22% (highest 10%). Conclusion In the assessment of performance of a prediction model, calibration is more important than discriminative capacity. Our prediction model shows that for women with gestational hypertension or mild preeclampsia at term, distinction between low and high risk of developing postpartum hemorrhage is possible when antepartum and intrapartum variables are combined.

KW - Preeclampsia

KW - calibration

KW - gestational hypertension

KW - predictive value

KW - prognostic model

KW - receiver-operating characteristic curve analysis

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U2 - 10.1111/aogs.12352

DO - 10.1111/aogs.12352

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SN - 0001-6349

VL - 93

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JO - Acta Obstetricia et Gynecologica Scandinavica

JF - Acta Obstetricia et Gynecologica Scandinavica

IS - 4

ER -

Prediction of postpartum hemorrhage in women with gestational hypertension or mild preeclampsia at term

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