AUTHOR=Dang Xiaohe , Zhang Li , Bao Yindi , Xu Jie , Du Hui , Wang Shaoshuai , Liu Yanyan , Deng Dongrui , Chen Suhua , Zeng Wanjiang , Feng Ling , Liu Haiyi 

TITLE=Developing and Validating Nomogram to Predict Severe Postpartum Hemorrhage in Women With Placenta Previa Undergoing Cesarean Delivery: A Multicenter Retrospective Case-Control Study

JOURNAL=Frontiers in Medicine

VOLUME=Volume 8 - 2021

YEAR=2022

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2021.789529

DOI=10.3389/fmed.2021.789529

ISSN=2296-858X

ABSTRACT=Objective: Developing and validating nomogram to predict severe postpartum hemorrhage in women with placenta previa undergoing cesarean delivery.
Methods: We conducted a multicenter retrospective case-control study in five hospitals. The 865 patients from January, 2018 to June, 2020 were enrolled in the development cohort, and 307 patients from July, 2020 to June, 2021 were enrolled in the validation cohort. Independent risk factors for severe postpartum hemorrhage were obtained by multivariate logistic regression, and preoperative nomogram and intraoperative nomogram were developed, respectively. We compared the discrimination, calibration and net benefit of the two nomograms in the development cohort and validation cohort. Then we tested whether the intraoperative nomogram could be used before operation.
Results: There were 204 patients (23.58%) in development cohort and 80 patients (26.06%) in validation cohort experienced severe postpartum hemorrhage. In development cohort, the areas under the receiver operating characteristic curve of the preoperative nomogram and intraoperative nomogram were 0.831 (95% CI, 0.804, 0.855) and 0.880 (95% CI, 0.854, 0.905), respectively. In validation cohort, the areas under the receiver operating characteristic curve of the preoperative nomogram and intraoperative nomogram were 0.825 (95% CI, 0.772, 0.877) and 0.853 (95% CI, 0.808, 0.898), respectively. In the validation cohort, the area under the receiver operating characteristic curve was 0.839 (95% CI, 0.789, 0.888) when the intraoperative nomogram was used before operation.
Conclusion: We developed the preoperative nomogram and intraoperative nomogram to predict severe postpartum hemorrhage in women with placenta previa undergoing cesarean delivery. By comparing the discrimination, calibration and net benefit of the two nomograms in development cohort and validation cohort, we think the intraoperative nomogram performed better. Moreover, application of the intraoperative nomogram before operation can still achieve good prediction effect, which can be improved if the severity of placenta accreta spectrum can be accurately distinguished preoperatively. We expect to conduct further prospective external validation studies on the intraoperative nomogram to evaluate its application value.