Change in Hemoglobin Was Not a Reliable Diagnostic Screening Test for Postpartum Hemorrhage: A French Prospective Multicenter Cohort Study (HERA Study)
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Setting
2.2. Selection of Participants
2.3. Interventions
2.4. Measurements
2.5. Outcomes
2.6. Analysis
3. Results
3.1. Characteristics of the Study Subjects
3.2. Main Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Deliveries with PPH | Global PPH 1 n = 2964 % [Mean ± SD] | Mild PPH 2 n = 1548 % [Mean ± SD] | Severe PPH 3 n = 1416 % [Mean ± SD] | p Value 4 |
---|---|---|---|---|
Singletons | 96.9 | 97.7 | 95.9 | 0.004 |
Women’s age | n = 2921 | n = 1528 | n = 1393 | |
[29.0 ± 5.4] | [28.7 ± 5.3] | [29.3 ± 5.4] | 0.001 | |
<18 years | 0.8 | 0.9 | 0.7 | 0.08 |
≥18–<35 years | 83.8 | 85.1 | 82.4 | |
≥35 years | 15.4 | 14.1 | 16.9 | |
PPH causes | ||||
Uterine atony | 58.7 | 56.3 | 61.3 | 0.005 |
Placental retention | 38.8 | 37.1 | 40.7 | 0.04 |
Vaginal and/or perineal lacerations | 25.2 | 25.7 | 24.7 | 0.5 |
Episiotomy | 19.9 | 20.9 | 18.9 | 0.2 |
Placenta previa | 2.1 | 1.7 | 2.5 | 0.1 |
Uterine rupture | 0.4 | 0.2 | 0.6 | 0.08 |
Cervical lacerations | 3.9 | 4.0 | 3.7 | 0.6 |
Vaginal wall hematoma | 1.4 | 1.3 | 1.5 | 0.6 |
Other 5 | 2.0 | 1.8 | 2.2 | 0.4 |
Total estimated blood loss (mL) | [913 ± 471] | [715 ± 106] | [1129 ± 602] | <0.0001 |
Blood loss estimations 6 | n = 2953 | n = 1544 | n = 1409 | |
Bag and/or aspiration and/or drains | 91.1 | 92.1 | 90.0 | 0.04 |
Weighed | 16.0 | 13.8 | 18.4 | 0.0007 |
Subjective measurement | 21.7 | 19.0 | 24.7 | 0.0002 |
Second-line pharmacological treatment | n = 2954 | n = 1542 | n = 1412 | |
Prostaglandin | 34.9 | 27.7 | 42.7 | <0.0001 |
Recombinant factor VII | 0.6 | 0.2 | 1.0 | 0.006 |
Fibrinogen | 3.1 | 0.7 | 5.7 | <0.0001 |
Iron infusion | 27.3 | 20.0 | 33.3 | 0.3 |
Tranexamic acid | 5.5 | 2.9 | 8.3 | <0.0003 |
Other | 3.8 | 3.4 | 4.2 | 0.3 |
Second-line nonpharmacological treatment | n = 2928 | n = 1529 | n = 1399 | |
Intrauterine balloon | 0.9 | 0.1 | 1.8 | <0.0001 |
Vascular embolization | 3.1 | 1.3 | 5.2 | <0.0001 |
Surgical acts | 43.2 | 43.5 | 42.8 | 0.7 |
B-Lynch | 0.3 | 0 | 0.6 | 0.003 |
Cho | 0.1 | 0 | 0.1 | 0.2 |
Hypogastric ligation | 0.3 | 0 | 0.6 | 0.001 |
Other vessel ligations | 0.5 | 0.3 | 0.9 | 0.04 |
Cervical suture | 3.4 | 3.2 | 3.5 | 0.6 |
Suture, vaginal wound | 40.4 | 41.3 | 39.3 | 0.2 |
Emergency hysterectomy | 0.4 | 0.1 | 0.9 | 0.001 |
Other surgery | 0.3 | 0.1 | 0.5 | 0.03 |
Transfusion | ||||
Yes | 13.6 | 5.6 | 22.4 | <0.0001 |
Mean number units of packed red blood cells | [3.0 ± 2.0] | [2.3 ± 0.8] | [3.3 ± 2.1] | <0.0001 |
Mean number fresh frozen plasma | [1.3 ± 2.1] | [0.3 ± 0.8] | [1.5 ±2.3] | <0.0001 |
Global PPH 1 n = 2964 % [Mean ± SD] Median (IQR 5) | Mild PPH 2 n = 1548 % [Mean ± SD] Median (IQR 5) | Severe PPH 3 n = 1416 % [Mean ± SD] Median (IQR 5) | p Value 4 | |
---|---|---|---|---|
Hemoglobin before delivery (g/L) | [119 ± 11] | [119 ± 11] | [119 ± 11] | 0.67 |
Lowest postpartum hemoglobin (g/L) | [89 ± 15] | [92 ± 14] | [86 ±16] | <0.0001 |
Hb Change (g/L) | [30 ± 14] | [27 ± 13] | [33 ± 15] | <0.0001 |
29 (19–39) | 26 (17–35) | 32 (22–42) | ||
Hb decrease > 10% | 90.4 | 87.9 | 93.0 | <0.0001 |
Hb decrease ≥ 20 g/L | 73.9 | 68.0 | 80.2 | <0.0001 |
Hb decrease ≥ 40 g/L | 23.7 | 17.5 | 30.5 | <0.0001 |
Global PPH 1 n = 2964 % (95%CI) | Mild PPH 2 n = 1548 % (95%CI) | Severe PPH 3 n = 1416 % (95%CI) | |
---|---|---|---|
HB decrease > 10% | |||
Sensitivity | 61.1 (59.2–62.9) | 66.4 (63.9–68.9) | 77.9 (75.7–80.2) |
Specificity | 60.8 (55.2–66.5) | 49.2 (42.0–56.4) | 49.5 (39.7–59.3) |
Positive predictive value | 93.6 (92.4–94.7) | 90.5 (88.7–92.3) | 95.4 (94.1–96.6) |
Negative predictive value | 14.3 (12.3–16.3) | 16.8 (13.6–20.0) | 14.4 (10.7–18.1) |
Positive likelihood ratio | 1.6 (1.3–1.8) | 1.3 (1.1–1.5) | 1.5 (1.2–1.8) |
Negative likelihood ratio | 0.6 (0.5–0.7) | 0.7 (0.6–0.8) | 0.4 (0.3–0.5) |
HB decrease ≥ 20 g/L | |||
Sensitivity | 59.4 (57.4–61.5) | 47.3 (44.3–50.3) | 51.8 (48.9–54.7) |
Specificity | 63.0 (59.6–66.4) | 64.2 (60.0–68.5) | 72.1 (66.9–77.4) |
Positive predictive value | 81.9 (80.0–83.8) | 73.8 (70.5–77.1) | 88.3 (85.9–90.7) |
Negative predictive value | 35.5 (32.9–38.0) | 36.4 (33.2–39.6) | 26.9 (23.8–30.1) |
Positive likelihood ratio | 1.6 (1.4–1.8) | 1.3 (0.08–1.9) | 1.9 (1.5–2.2) |
Negative likelihood ratio | 0.6 (0.5–0.7) | 0.8 (0.7–0.9) | 0.7 (0.6–0.7) |
HB decrease ≥ 40 g/L | |||
Sensitivity | 61.7 (58.1–65.3) | 55.0 (49.1–60.9) | 54.9 (50.2–59.6) |
Specificity | 64.4 (62.4–66.3) | 58.7 (56.0–61.4) | 66.1 (63.1–69.0) |
Positive predictive value | 35.0 (32.4–37.7) | 22.0 (18.9–25.2) | 41.5 (37.5–45.6) |
Negative predictive value | 84.4 (82.7–86.1) | 86.0 (83.7–88.3) | 76.9 (74.1–79.8) |
Positive likelihood ratio | 1.7 (1.6–1.9) | 1.3 (0.2–1.5) | 1.6 (1.4–1.8) |
Negative likelihood ratio | 0.7 (0.6–0.7) | 0.8 (0.7–0.9) | 0.7 (0.6–0.8) |
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Barasinski, C.; Pranal, M.; Léger, S.; Debost-Legrand, A.; Vendittelli, F. Change in Hemoglobin Was Not a Reliable Diagnostic Screening Test for Postpartum Hemorrhage: A French Prospective Multicenter Cohort Study (HERA Study). Healthcare 2023, 11, 1111. https://doi.org/10.3390/healthcare11081111
Barasinski C, Pranal M, Léger S, Debost-Legrand A, Vendittelli F. Change in Hemoglobin Was Not a Reliable Diagnostic Screening Test for Postpartum Hemorrhage: A French Prospective Multicenter Cohort Study (HERA Study). Healthcare. 2023; 11(8):1111. https://doi.org/10.3390/healthcare11081111
Chicago/Turabian StyleBarasinski, Chloé, Marine Pranal, Stéphanie Léger, Anne Debost-Legrand, and Françoise Vendittelli. 2023. "Change in Hemoglobin Was Not a Reliable Diagnostic Screening Test for Postpartum Hemorrhage: A French Prospective Multicenter Cohort Study (HERA Study)" Healthcare 11, no. 8: 1111. https://doi.org/10.3390/healthcare11081111